van Zwol-Janssens Charissa, van Rosmalen Mandy M, Oomen-de Hoop Esther, Drooger Jan C, van der Padt-Pruijsten Annemieke, Zuetenhorst Hanneke J M, Louwers Yvonne V, Visser Jenny A, Laven Joop S E, Jager Agnes
Division Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University MC, Rotterdam, the Netherlands.
Breast. 2025 Aug 19;83:104562. doi: 10.1016/j.breast.2025.104562.
Optimal endocrine therapy for premenopausal breast cancer patients after chemotherapy requires accurate menopausal status assessment. Current methods for determining resumption of ovarian function after chemotherapy are suboptimal. This study aims to evaluate the predictive value of pretreatment anti-Müllerian hormone (AMH) serum levels for predicting resumption of ovarian function after chemotherapy (CT).
This prospective study included premenopausal women with hormone receptor-positive breast cancer undergoing CT. AMH was measured using the picoAMH assay of Anshlabs. The primary outcome was resumption of ovarian function, defined as menstrual cycle resumption or estradiol levels above 110 pmol/L within 24 months after CT.
Among 109 patients, pretreatment AMH was a strong predictor of resumption of ovarian function (AUC 0.86) and an optimal cut-off of 0.62 μg/L was calculated. AMH >0.62 μg/L identified women at higher risk for ovarian function resumption (sensitivity 69.9 %, specificity 88.5 %), with a false negative rate of 11.5 % and false positive rate of 30.1 %. Combining AMH and age improved predictive accuracy only slightly. No additional predictors were identified. Survival analysis confirmed that women with low pretreatment AMH (<0.62 μg/L) or older age (>40.2 years) experienced significantly less frequent and delayed ovarian function resumption.
Pretreatment AMH is a valuable tool for predicting ovarian function resumption after chemotherapy in breast cancer patients, so that a GnRH agonist can be recommended appropriately. However, the predictive value of pretreatment AMH for permanent ovarian insufficiency is too limited to determine the postmenopausal status sufficiently accurately to switch upfront to another endocrine treatment, the aromatase inhibitors.
绝经前乳腺癌患者化疗后的最佳内分泌治疗需要准确评估绝经状态。目前用于确定化疗后卵巢功能恢复的方法并不理想。本研究旨在评估化疗前抗苗勒管激素（AMH）血清水平对预测化疗后卵巢功能恢复的价值。
这项前瞻性研究纳入了接受化疗的激素受体阳性绝经前乳腺癌女性患者。使用Anshlabs的picoAMH检测法测量AMH。主要结局是卵巢功能恢复，定义为化疗后24个月内月经周期恢复或雌二醇水平高于110 pmol/L。
在109例患者中，化疗前AMH是卵巢功能恢复的有力预测指标（曲线下面积为0.86），计算得出的最佳截断值为0.62 μg/L。AMH>0.62 μg/L可识别出卵巢功能恢复风险较高的女性（敏感性为69.9%，特异性为88.5%），假阴性率为11.5%，假阳性率为30.1%。联合AMH和年龄仅略微提高了预测准确性。未发现其他预测指标。生存分析证实，化疗前AMH水平低（<0.62 μg/L）或年龄较大（>40.2岁）的女性卵巢功能恢复的频率明显较低且延迟。
化疗前AMH是预测乳腺癌患者化疗后卵巢功能恢复的有价值工具，因此可适当推荐使用促性腺激素释放激素激动剂。然而，化疗前AMH对永久性卵巢功能不全的预测价值过于有限，无法充分准确地确定绝经状态，从而无法直接改用另一种内分泌治疗药物芳香化酶抑制剂。
