Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California.
Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, California; Moores Cancer Center, University of California, San Diego, California.
Fertil Steril. 2022 May;117(5):1047-1056. doi: 10.1016/j.fertnstert.2022.01.016. Epub 2022 Feb 23.
To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data.
In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups.
Commercially insured females in the United States.
PATIENT(S): Females with and without breast cancer.
EXPOSURE(S): Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy.
MAIN OUTCOME MEASURE(S): AMH levels.
RESULT(S): A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed.
CONCLUSION(S): In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.
利用行政数据比较 6 年内乳腺癌发病后按癌症状态和治疗暴露情况的抗苗勒管激素（AMH）模式。
在一项横断面设计中，将 2005-2019 年期间年龄在 15-39 岁之间患有乳腺癌的患者的 AMH 水平与 OptumLabs 数据仓库中无癌症的女性进行 1:10 匹配。比较了基于环磷酰胺的化疗、非环磷酰胺的化疗、无化疗和无乳腺癌组的模型化 AMH 模式。
美国商业保险女性。
患有和不患有乳腺癌的女性。
乳腺癌、环磷酰胺和非环磷酰胺化疗。
AMH 水平。
共 233 名乳腺癌患者（平均年龄 34 岁，标准差 3.7 岁）在诊断后中位数为 2 年（范围 0-6.7 年）内贡献了 278 个 AMH 水平；52%接受了基于环磷酰胺的化疗，17%接受了非环磷酰胺的化疗（80%为铂类），31%未接受化疗。共有 2777 名无癌症的匹配女性贡献了 2780 个 AMH 水平。4 组的 AMH 水平模式不同。在未接受化疗的无癌症和乳腺癌幸存者中，AMH 随时间呈线性下降。相比之下，接受环磷酰胺和非环磷酰胺化疗的患者，AMH 水平在化疗期间最初下降，随后在 2-4 年内增加，然后在 1-2 年内达到平台，然后下降。
在乳腺癌幸存者中，来自行政数据的 AMH 水平支持了非环磷酰胺化疗对乳腺癌的卵巢毒性，并有效地描述了卵巢储备变化的时间和持续时间，以反映剩余的生殖寿命。
