Pretreatment anti-Müllerian Hormone Predicts for Loss of Ovarian Function After Chemotherapy for Early Breast Cancer

Eur J Cancer. 2013 Nov;49(16):3404-11. doi: 10.1016/j.ejca.2013.07.014. Epub 2013 Aug 19.

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.

Keywords: AMH; Amenorrhoea; Breast cancer; Chemotherapy; Fertility; Ovarian reserve.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amenorrhea / blood
  • Amenorrhea / chemically induced*
  • Amenorrhea / physiopathology
  • Anti-Mullerian Hormone / blood*
  • Antineoplastic Agents / adverse effects*
  • Area Under Curve
  • Biomarkers, Tumor / blood*
  • Breast Neoplasms / blood
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Denmark
  • Down-Regulation
  • Early Detection of Cancer
  • Female
  • Follicle Stimulating Hormone, Human / blood
  • Humans
  • Inhibins / blood
  • Logistic Models
  • Middle Aged
  • Odds Ratio
  • Ovary / drug effects*
  • Ovary / metabolism
  • Ovary / physiopathology
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Scotland
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Follicle Stimulating Hormone, Human
  • inhibin B
  • Inhibins
  • Anti-Mullerian Hormone