Lee Dong-Yun, Kim Ji-Yeon, Yu Jonghan, Kim Seok Won
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2020 Jun 16;10:863. doi: 10.3389/fonc.2020.00863. eCollection 2020.
It is important to identify factors predicting successful ovarian protection using gonadotropin-releasing hormone (GnRH) agonists during chemotherapy. However, only a few studies have prospectively assessed this issue in young breast cancer patients. This study evaluated the predictive factors for successful ovarian protection with GnRH agonists during chemotherapy in young estrogen receptor-negative breast cancer patients. This prospective study analyzed 67 estrogen receptor-negative breast cancer patients ≤40 years of age who were longitudinally assessed after receiving GnRH agonists during cyclophosphamide-based chemotherapy for ovarian protection. Associations between clinical characteristics or pretreatment hormones and successful ovarian protection [resumption of menstruation and anti-Müllerian hormone (AMH) ≥1 ng/ml]. The mean age and pretreatment serum level of AMH were 33.2 years and 4.57 ng/ml, respectively. At 12 months after the completion of chemotherapy, most women (97%) experienced the resumption of menstruation. However, the proportion of patients with AMH ≥1 ng/ml at 12 months was 70.1%. In multivariate analyses, only the pretreatment serum AMH level ( < 0.001) was predictive for AMH ≥1 ng/ml at 12 months. Receiver operating characteristic curve analyses of pretreatment AMH exhibited an area under the curve of 0.866 (95% CI = 0.777-0.955) for AMH ≥1 ng/ml at 12 months. The cutoff value for the prediction of AMH concentration ≥1 ng/ml at 12 months was 2.87 ng/ml of pretreatment AMH with a sensitivity of 0.87 and a specificity of 0.75. Pretreatment AMH (2.87 ng/ml) is a useful predictor for AMH ≥1 ng/ml at 12 months after receiving GnRH agonists in young estrogen receptor-negative breast cancer patients. This finding can help improve decision-making regarding fertility preservation.
识别化疗期间使用促性腺激素释放激素（GnRH）激动剂成功保护卵巢的预测因素很重要。然而，只有少数研究前瞻性地评估了年轻乳腺癌患者的这一问题。本研究评估了年轻雌激素受体阴性乳腺癌患者化疗期间使用GnRH激动剂成功保护卵巢的预测因素。这项前瞻性研究分析了67例年龄≤40岁的雌激素受体阴性乳腺癌患者，这些患者在接受基于环磷酰胺的化疗期间为保护卵巢而接受GnRH激动剂治疗后进行了纵向评估。临床特征或治疗前激素与成功保护卵巢[月经恢复和抗苗勒管激素（AMH）≥1 ng/ml]之间的关联。AMH的平均年龄和治疗前血清水平分别为33.2岁和4.57 ng/ml。化疗结束后12个月，大多数女性（97%）月经恢复。然而，12个月时AMH≥1 ng/ml的患者比例为70.1%。在多变量分析中，只有治疗前血清AMH水平（<0.001）可预测12个月时AMH≥1 ng/ml。治疗前AMH的受试者工作特征曲线分析显示，12个月时AMH≥1 ng/ml的曲线下面积为0.866（95%CI=0.777-0.955）。预测12个月时AMH浓度≥1 ng/ml的临界值为治疗前AMH 2.87 ng/ml，敏感性为0.87，特异性为0.75。治疗前AMH（2.87 ng/ml）是年轻雌激素受体阴性乳腺癌患者接受GnRH激动剂治疗后12个月时AMH≥1 ng/ml的有用预测指标。这一发现有助于改善关于生育力保护的决策。
