Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Department of Surgery, Konkuk University Medical Center, Seoul, South Korea.
Breast Cancer Res. 2024 Nov 5;26(1):152. doi: 10.1186/s13058-024-01903-9.
Chemo-endocrine therapy can lead to various side effects associated with ovarian dysfunction. Predicting menstrual recovery is necessary to discuss the treatment-related issues regarding fertility and premature menopause with patients.
In the ASTRRA trial, patients who resumed ovarian function within 2 years after chemotherapy were randomized to receive tamoxifen for 5 years or OFS with tamoxifen for 2 years. With these 1298 patients, we developed a model that predicts when menstrual recovery will occur within a 3-year period after chemotherapy using variables including age, body mass index, chemotherapy regimen and duration, and serum estradiol and follicle-stimulating hormone levels.
The data of 957 patients were used to develop the prediction model, and those of 341 patients were used for validation. In the development group, menstruation resumed in 450 patients (47.0%) within 5 years. In multivariable analysis, younger age (< 35 vs. 45, HR 7.85, 95% CI 4.63-13.30, p < 0.0001), anthracycline-based chemotherapy without taxane (vs. with taxane, HR 1.81, 95% CI 1.37-2.38, p < 0.0001), and chemotherapy duration (≤ 90 days vs. > 90 days, HR 1.32, 95% CI 1.01-1.72, p = 0.045) correlated with menstrual recovery. Using combined age, regimen, and duration of chemotherapy, we developed a simplified scoring system to estimate recovery chances and used a concordance index of 0.679 overall and 0.744 at 3 years for validation.
This model predicted timing and probability of menstrual recovery, based on their individual age, type and duration of chemotherapy in premenopausal women diagnosed with breast cancer who received tamoxifen after chemotherapy.
化疗-内分泌治疗可导致与卵巢功能障碍相关的各种副作用。预测月经恢复有助于与患者讨论与生育和早绝经相关的治疗问题。
在 ASTRRA 试验中，化疗后 2 年内恢复卵巢功能的患者被随机分配接受他莫昔芬治疗 5 年或 OFS 联合他莫昔芬治疗 2 年。我们利用包括年龄、体重指数、化疗方案和持续时间以及血清雌二醇和卵泡刺激素水平在内的变量，对 1298 例患者进行分析，建立了一个预测化疗后 3 年内月经恢复时间的模型。
利用 957 例患者的数据建立预测模型，利用 341 例患者的数据进行验证。在开发组中，450 例（47.0%）患者在 5 年内恢复月经。多变量分析显示，年龄较小（<35 岁 vs. 45 岁，HR 7.85，95%CI 4.63-13.30，p<0.0001）、不含紫杉烷的蒽环类药物化疗（vs. 含紫杉烷，HR 1.81，95%CI 1.37-2.38，p<0.0001）和化疗持续时间（≤90 天 vs. >90 天，HR 1.32，95%CI 1.01-1.72，p=0.045）与月经恢复相关。我们利用联合年龄、方案和化疗持续时间建立了一个简化的评分系统来估计恢复的可能性，并在验证时获得了总体 0.679 和 3 年时 0.744 的一致性指数。
该模型基于化疗前接受他莫昔芬治疗的乳腺癌绝经前妇女的个体年龄、化疗类型和持续时间，预测了化疗后月经恢复的时间和概率。
