Department of Breast Surgery, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
Cancer Hospital of the University of Chinese Academy of Science (Zhejiang Cancer Hospital), 1 Banshan Road, Hangzhou, 310022, China.
Breast. 2022 Aug;64:143-150. doi: 10.1016/j.breast.2022.05.009. Epub 2022 Jun 2.
As a special reproductive hormone and ovarian reserve indicator, the role of anti-Müllerian hormone (AMH) in premenopausal women with breast cancer deserves further study.
We conducted an in-depth analysis of the data from the EGOFACT study (NCT02518191), a phase Ⅲ, randomized, controlled trial involving premenopausal female breast cancer patients in two parallel groups: chemotherapy with or without gonadotropin-releasing hormone analogs (GnRHa). Three hundred thirty premenopausal women aged 25-49 years with operable stage I to III breast cancer were included in this study. The characteristics of ovarian reserve changes marked by AMH in the EGOFACT study and the factors affecting ovarian function in premenopausal women with breast cancer were analyzed.
The AMH level of the chemotherapy alone group decreased gradually within one year, while the AMH level of the GnRHa group was significantly higher as early as 6 months after chemotherapy and recovered to close to the baseline level 12 months after chemotherapy (F = 34.991, P < 0.001). Correlation analysis showed that the factors affecting AMH levels mainly included age, menarche age, body mass index (BMI), reproductive history, baseline follicle stimulating hormone (FSH) level, pathological stage and GnRHa application, but they had different effects on the incidence of premature ovarian insufficiency (POI) at different periods. Multivariate logistic regression analysis showed that menarche age younger than 14 years (OR 0.470 [0.259, 0.852], P = 0.013), baseline AMH level higher than 0.5 ng/mL (OR 9.590 [3.366, 27.320], P < 0.001), pathological stage Ⅰ(OR 0.315 [0.124, 0.798], P = 0.015) and GnRHa application (OR 0.090 [0.045, 0.183], P < 0.001) were independent factors conducive to protection of ovarian reserve, as well as to recovery of ovarian reserve.
Age, menarche age, baseline AMH level, and GnRHa application are the most important influencing factors for ovarian reserve in premenopausal women with breast cancer.
ClinicalTrials.gov, NCT02518191, registered on Aug 5, 2015.
抗苗勒管激素（AMH）作为一种特殊的生殖激素和卵巢储备指标，其在绝经前乳腺癌患者中的作用值得进一步研究。
我们对 EGOFACT 研究（NCT02518191）的数据进行了深入分析，该研究是一项涉及两组绝经前女性乳腺癌患者的 3 期、随机、对照试验：化疗加或不加促性腺激素释放激素类似物（GnRHa）。该研究纳入了 330 名年龄在 25-49 岁、可手术的 I 期至 III 期乳腺癌绝经前女性，分析了 AMH 标记的卵巢储备变化特征以及影响乳腺癌绝经前女性卵巢功能的因素。
化疗组的 AMH 水平在一年内逐渐下降，而 GnRHa 组的 AMH 水平在化疗后 6 个月即显著升高，并在化疗后 12 个月恢复到接近基线水平（F=34.991，P<0.001）。相关性分析表明，影响 AMH 水平的因素主要包括年龄、初潮年龄、体重指数（BMI）、生育史、基础卵泡刺激素（FSH）水平、病理分期和 GnRHa 的应用，但它们对不同时期的卵巢早衰（POI）发生率有不同的影响。多变量逻辑回归分析表明，初潮年龄<14 岁（OR 0.470 [0.259, 0.852]，P=0.013）、基础 AMH 水平>0.5ng/mL（OR 9.590 [3.366, 27.320]，P<0.001）、病理分期Ⅰ期（OR 0.315 [0.124, 0.798]，P=0.015）和 GnRHa 的应用（OR 0.090 [0.045, 0.183]，P<0.001）是有利于保护卵巢储备和恢复卵巢储备的独立因素。
年龄、初潮年龄、基础 AMH 水平和 GnRHa 的应用是绝经前乳腺癌患者卵巢储备的最重要影响因素。
ClinicalTrials.gov，NCT02518191，注册于 2015 年 8 月 5 日。
