Anti-Müllerian hormone as a new marker of the individualized ovarian function suppression treatment for premenopausal breast cancer patients: a cohort study
10.3760/cma.j.cn101441-20200707-00382
- VernacularTitle:AMH对绝经前乳腺癌患者卵巢抑制治疗中卵巢功能的评价作用：一项队列研究
- Author:
Huaping LI
1
;
Siyu WU
;
Yongnian WANG
;
Zhou LIU
;
Qing LIU
;
Ping LI
;
Guangyu LIU
Author Information
1. 上海健康医学院附属周浦医院妇产科，上海 201318
- Publication Type:Journal Article
- Keywords:
Anti-Müllerian hormone;
Goserelin;
Breast Neoplasms;
Ovarian function suppression
- From:
Chinese Journal of Reproduction and Contraception
2022;42(2):156-164
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the role of anti-Müllerian hormone (AMH) on the ovarian function evaluation in premenopausal breast cancer patients with hormone receptor positive after different courses of ovarian function suppression (OFS) treatment.Methods:This study was a two-way cohort study. The main endpoints of the study were menstrual recovery and hormone changes after OFS treatment. Totally sixty-seven premenopausal breast cancer patients were enrolled, whose estrogen receptor (ER) and progesterone receptor (PR) had been tested positive from May 2015 to May 2019, and who had undergone operations, chemotherapies and OFS treatments for 24-60 months in Fudan University Shanghai Cancer Center. Twelve cases were eliminated because of missing tracking. The enrolled cases were divided into 2 groups according to OFS treatment, group A was treated with goserelin for 24 months ( n=32), and group B, with goserelin for 25-60 months ( n=23). Following the OFS treatment, the time points of menstrual recovery were observed and the serum levels of AMH, follicle-stimulating hormone (FSH) and estrogen (E 2) levels were measured in the two groups. Results:The follow-up period of the two groups was (42.0±12.3) months. All the patients survived their follow-ups, except one who developed recurrence and metastasis in the 25-60 month course of OFS. No significant differences were observed in age, height, weight, body mass index (BMI), menarche age, pathological type, pathological grade, ER, PR positive rate, human epidermal growth factor receptor-2 (HER-2) positive rate, sequence of chemotherapy and OFS treatment between the two groups (all P>0.05). The time of menstruation recovery was longer in group A than in group B, the menstruation recovery rate became lower, and the regular rate of menstruation became lower, but there was no significant difference (all P>0.05). After the completion of OFS treatment, the change of AMH and FSH levels in the second year was significantly different from that in the first year ( P=0.003, P=0.004), and the change of AMH and E 2 levels was statistically different between the third year and the second year ( P=0.045, P=0.003). Compared with group B, the serum AMH levels of group A showed decrease after 1, 2 and 3 years, respectively [(0.53±0.15) μg/L vs. (1.01±0.4) μg/L; (0.91±0.25) μg/L vs. (1.38±0.57) μg/L; (1.07±0.23) μg/L vs. (1.55±0.64) μg/L]. Compared with the 1-year serum AMH levels, those of 2-year and 3-year increased 51.5% and 72.1%, respectively. In group A, the serum AMH levels increased 71.7% and 101.9%, respectively, after 2 and 3 years. In group B, the serum AMH levels increased 36.6% and 53.5%, respectively, after 2 and 3 years. The serum E 2, FSH levels were higher or lower in group A than in group B after 1,2, 3 years, showing no significant difference ( P>0.05). Additionally, the differences in serum E 2 levels were statistically significant after 2 years of OFS treatment ( U=520.51,P=0.009). Compared with the 1-year serum E 2 levels, those of 2-year and 3-year decreased 14.8% and increased 59.1%, respectively. In group A, the serum E 2 levels decreased 29.4% and increased 67.6%, respectively, after 2 and 3 years. In group B, the serum E 2 levels decreased 4.4% and increased 52.5%, respectively, after 2 and 3 years. Compared with the 1-year serum FSH levels, those of 2-year and 3-year increased 44.7%, 41.6%, respectively. In group A, the serum FSH levels increased 41.1%, 44.3%, respectively, after 2 and 3 years. In group B, the serum FSH levels increased 48.6%, 47.0%, respectively, after 2 and 3 years. Conclusion:Compared with E 2 and FSH, AMH is more likely to be a used clinically to evaluate the ovarian reserve of breast cancer patients. There is no statistical difference in different OFS courses on the ovarian function of premenstrual breast cancer patients. The ovarian function of patients with the short OFS courses could recover more quickly than those with the long OFS courses. It was necessary to monitor the E 2 levels regularly during OFS treatment.
