抗苗勒氏管激素对绝经前早期乳腺癌患者化疗后卵巢功能的预测价值

Predictive value of anti-Mullerian hormone on ovarian function after chemotherapy in premenopausal early breast cancer patients

目的:探讨血清标志物抗苗勒氏管激素(anti-Mullerian hormone,AMH)等对出现化疗诱导闭经的绝经前早期乳腺癌患者是否卵巢功能衰竭(ovarian failure,OVF)的预测价值,以优化辅助治疗策略及保护生育功能。方法:前瞻性分析2016年4月至2018年12月60例于广州医科大学附属第三医院行含环磷酰胺化疗方案的绝经前早期乳腺癌患者临床资料,监测化疗前后血清中的AMH、卵泡刺激素(follicle stimulating hormone,FSH)和雌二醇(estradiol,E2)水平变化。根据化疗结束后中位随访时间24个月时,E2、FSH是否维持在绝经后参考范围内,分为OVF组和卵巢功能恢复(ovarian recovery,OVR)组,分析对化疗后OVF的预测价值。结果:化疗前AMH预测化疗后24个月卵巢功能的曲线下面积(area under curve,AUC)为0.837(95%CI为0.719~0.920),年龄联合化疗前血清AMH等预测的AUC为0.924(95%CI为0.826~0.977)。化疗前的AMH≤1.05 ng/mL,1个疗程化疗后AMH≤0.56 ng/mL,化疗结束后3~6个月FSH>25.01 U/L及诊断年龄>37岁的阴性预测值均为100%。结论:血清AMH联合E2和FSH检测对鉴别绝经前早期乳腺癌患者化疗后是否OVF有重要价值,可将AMH纳入化疗前常规检测。

Objective:To explore the predictive value of serum markers,such as the anti-Mullerian hormone(AMH),for ovarian failure(OVF)in premenopausal early breast cancer patients with chemotherapy-induced amenorrhea,in order to optimize adjuvant therapy and protect fertility.Methods:Prospectively,60 premenopausal patients with early breast cancer receiving cyclophosphamide-containing chemotherapy in The Third Affiliated Hospital of Guangzhou Medical University from April 2016 to December 2018 were analyzed.The dy-namic changes of serum AMH,follicle stimulating hormone(FSH),and estradiol(E2)levels were monitored before and after chemotherapy to analyze their predictive value for OVF 24 months after chemotherapy.Results:Pre-chemotherapy AMH exhibited a good predictive value for OVF 24 months after chemotherapy with an area under curve(AUC)of 0.837[95%confidence interval(CI):0.719–0.920]and an AUC was 0.924(95%CI:0.826–0.977)for age combined with pre-chemotherapy AMH and other hormone levels;pre-chemotherapy AMH≤1.05 ng/mL,AMH≤0.56 ng/mL after 1 cycle,FSH>25.01 U/L at 3–6 months after chemotherapy and age at diagnosis>37 years showed a 100%negative predictive value.Conclusions:AMH combined with E2 and FSH detection is valuable in early identification of OVF after chemotherapy in premenopausal breast cancer patients.Therefore,we posit that AMH be included in the routine testing prior to chemotherapy.