Pretreatment anti-Müllerian hormone predicts for loss of ovarian function after chemotherapy for early breast cancer

Richard A. Anderson, Mikkel Rosendahl, Thomas W. Kelsey, David A. Cameron

Research output: Contribution to journalArticlepeer-review

Abstract

Aim
Improving survival for women with early breast cancer (eBC) requires greater attention to the consequences of treatment, including risk to ovarian function. We have assessed whether biochemical markers of the ovarian reserve might improve prediction of chemotherapy related amenorrhoea.
Methods
Women (n = 59, mean age 42.6 years [(range 23.3–52.5]) with eBC were recruited before any treatment. Pretreatment ovarian reserve markers (anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], inhibin B) were analysed in relation to ovarian status at 2 years.
Results

Pretreatment AMH was significantly lower in women with amenorrhoea at 2 years (4.0 ± 0.9 pmol/L versus 17.2 ± 2.5, P < 0.0001), but FSH and inhibin B did not differ between groups. By logistic regression, pretreatment AMH, but not age, FSH or inhibin B, was an independent predictor of ovarian status at 2 years (P = 0.005; odds ratio 0.013). We combined these data with a similar cohort (combined n = 75); receiver–operator characteristic analysis for AMH gave area under curve (AUC) of 0.90 (95% confidence interval (CI) 0.82–0.97)). A cross-validated classification tree analysis resulted in a binary classification schema with sensitivity 98.2% and specificity 80.0% for correct classification of amenorrhoea.
Conclusion
Pretreatment AMH is a useful predictor of long term post chemotherapy loss of ovarian function in women with eBC, adding significantly to the only previously established individualising predictor, i.e. age. AMH measurement may assist decision-making regarding treatment options and fertility preservation procedures.
Original languageEnglish
Pages (from-to)3404-3411
Number of pages8
JournalEuropean Journal of Cancer
Volume49
Issue number16
Early online date19 Aug 2013
DOIs
Publication statusPublished - Nov 2013

Keywords

  • Adult
  • Amenorrhea
  • Anti-Mullerian Hormone
  • Antineoplastic Agents
  • Area Under Curve
  • Breast Neoplasms
  • Denmark
  • Down-Regulation
  • Early Detection of Cancer
  • Female
  • Follicle Stimulating Hormone, Human
  • Humans
  • Inhibins
  • Logistic Models
  • Middle Aged
  • Odds Ratio
  • Ovary
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Scotland
  • Time Factors
  • Treatment Outcome
  • Tumor Markers, Biological
  • Young Adult

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