Prediction of ovarian function recovery in young breast cancer patients after protection with gonadotropin-releasing hormone agonist during chemotherapy.

Abstract

This study evaluated predictive factors for recovery of ovarian function after ovarian protection by GnRH agonist during chemotherapy in young breast cancer patients. This prospective cohort study analyzed 105 young breast cancer patients who were studied longitudinally after receiving GnRH agonist during cyclophosphamide-based chemotherapy for ovarian protection. Associations between pretreatment hormones, clinical factors, and recovery of ovarian function (resumption of menstruation or anti-Müllerian hormone (AMH) ≥ 1ng/ml) were evaluated at 12 months and long-term follow-up after completion of chemotherapy. Mean age was 32years (range 23-42years). In multivariate analyses, tamoxifen use (P = 0.035) and pretreatment follicle-stimulating hormone (FSH) (P = 0.032) were predictive of resumption of menstruation, and age (P = 0.019), tamoxifen use (P = 0.022), pretreatment FSH (P < 0.001), and AMH (P = 0.040) were predictors for AMH ≥ 1ng/ml at 12months. In addition, pretreatment AMH was a predictor for AMH ≥ 1ng/ml after long-term follow-up. Receiver operating characteristic curve analyses gave area under the curve of 0.805 for resumption of menstruation and 0.903 for serum AMH concentration ≥ 1ng/ml at 12 months, when age, tamoxifen use, pretreatment FSH, and AMH were combined. Pretreatment AMH (3.26ng/ml), age (33.9years), pretreatment FSH (5.5IU/l), and tamoxifen use are useful predictors for AMH ≥ 1ng/ml at 12months after GnRH agonist. This finding will support patient and clinician decision-making regarding fertility preservation.