MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States.
Front Endocrinol (Lausanne). 2020 Oct 7;11:574263. doi: 10.3389/fendo.2020.574263. eCollection 2020.
Cancer treatments can be damaging to the ovary, with implications for future fertility and reproductive lifespan. There is therefore a need for a biomarker than can usefully provide an assessment of the ovary and its potential for long-term function after cancer treatment, and ideally also be of value pre-treatment, for the prediction of post-treatment function. In this review we assess the value of anti-Müllerian hormone (AMH) in this context. Measurement of AMH at the time of cancer diagnosis has been shown to be predictive of whether or not there will remain some ovarian function post-treatment in women with breast cancer, in conjunction with age. AMH may however be reduced at the time of diagnosis in some conditions, including lymphoma, but probably not in women with breast cancer unless they are carriers of mutations. Following chemotherapy, AMH is often much reduced compared to pretreatment levels, with recovery dependent on the chemotherapy regimen administered, the woman's age, and her pretreatment AMH. Recent data show there may be a long duration of relative stability of AMH levels over 10 to 15 years prior to decline rather than a rapid decline for many young women after cancer. Post-treatment AMH may have utility in determining that ovarian function will not recover, contributing to assessment of the need for ovarian suppression in women with hormone-sensitive breast cancer. AMH measurement provides an index of treatment gonadotoxicity, allowing comparison of different treatment regimens, although extrapolation to effects on fertility requires caution, and there are very limited data regarding the use of AMH to estimate time to menopause in the post-cancer setting.
癌症治疗可能会对卵巢造成损害，影响未来的生育能力和生殖寿命。因此，需要有一种生物标志物，能够有效地评估卵巢及其在癌症治疗后的长期功能潜力，并且在理想情况下，在治疗前也能预测治疗后的功能。在这篇综述中，我们评估了抗苗勒管激素（AMH）在这方面的价值。在乳腺癌患者中，癌症诊断时的 AMH 测量值与年龄一起，可以预测治疗后是否会保留一些卵巢功能。然而，在某些情况下，包括淋巴瘤，AMH 在诊断时可能会降低，但在乳腺癌患者中可能不会，除非她们是基因突变的携带者。化疗后，AMH 水平通常比治疗前低得多，恢复情况取决于所使用的化疗方案、女性的年龄和她的治疗前 AMH 水平。最近的数据表明，在下降之前，AMH 水平可能会有长达 10 到 15 年的相对稳定期，而不是许多年轻女性在癌症后迅速下降。治疗后 AMH 可能有助于确定卵巢功能不会恢复，有助于评估对激素敏感型乳腺癌女性进行卵巢抑制的需求。AMH 测量提供了治疗性腺毒性的指标，允许比较不同的治疗方案，尽管对生育能力的推断需要谨慎，并且关于在癌症后环境中使用 AMH 来估计绝经时间的数据非常有限。
