Prediction of Postchemotherapy Ovarian Function Using Markers of Ovarian Reserve

[摘要] Background. Reproductive-aged women frequently receive both chemotherapy and endocrine therapy as part of their treatment regimen forearly stage hormone receptor-positive breast cancer. Chemotherapy results in transient or permanent ovarian failure in themajority of women. The difficulty in determining which patients will recover ovarian function has implications for adjuvantendocrine therapy decision making. We hypothesized that pretreatment serum anti-Müllerian hormone (AMH) and inhibin B concentrationswould predict for ovarian function following chemotherapy.Methods. Pre- and perimenopausal women aged 25�?50 years with newly diagnosed breast cancer were enrolled. Subjects underwent phlebotomyfor assessment of serum AMH, inhibin B, follicle-stimulating hormone, and estradiol prior to chemotherapy and 1 month and1 year following completion of treatment. Associations among hormone concentrations, clinical factors, and biochemically assessedovarian function were assessed.Results. Twenty-seven subjects were evaluable for the primary endpoint. Median age was 41. Twenty subjects (74.1%) experienced recoveryof ovarian function within 18 months. Of the 26 evaluable subjects assessed prior to chemotherapy, 19 (73.1%) had detectableserum concentrations of AMH. The positive predictive value of a detectable baseline serum AMH concentration for recovery ofovarian function was 94.7%, and the negative predictive value was 85.7%. On univariate analysis, younger age and detectableserum AMH concentration at chemotherapy initiation were predictive of increased likelihood of recovery of ovarian function.Conclusion. Prechemotherapy assessment of serum AMH may be useful for predicting postchemotherapy ovarian function. This finding hasimplications for decision making about adjuvant endocrine therapy in premenopausal women treated with chemotherapy.

[学科分类] 肿瘤学