AMH对绝经前乳腺癌患者卵巢抑制治疗中卵巢功能的评价作用:一项队列研究  

Anti-Müllerian hormone as a new marker of the individualized ovarian function suppression treatment for premenopausal breast cancer patients:a cohort study

作　　者：李华萍 邬思雨 王永年 柳洲 刘青[4] 李萍 柳光宇 Li Huaping;Wu Siyu;Wang Yongnian;Liu Zhou;Liu Qing;Li Ping;Liu Guangyu(Department of Obstetrics and Gynecology,Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai 201318,China;Department of Breast Cancer,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Clinical Laboratory,Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai 201318,China;Department of Gynecological Oncology,Renji Hospital Affiliated to Shanghai Jiao Tong University,School of Medicine,Shanghai 200001,China;Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院妇产科,上海201318 [2]复旦大学附属肿瘤医院乳腺科,上海200032 [3]上海健康医学院附属周浦医院检验科,上海201318 [4]上海交通大学医学院附属仁济医院妇瘤科,上海200001 [5]上海健康医学院医疗器械学院,上海201318

出　　处：《中华生殖与避孕杂志》2022年第2期156-164,共9页Chinese Journal of Reproduction and Contraception

基　　金：上海市浦东新区学科带头人培养项目(PWRd2016-15)上海市卫计委面上项目(201740291)上海市浦东新区科学技术委员会民生科研专项基金(PKJ2021-Y30)。

摘　　要：目的探讨抗苗勒管激素(anti-Müllerian hormone,AMH)对绝经前激素受体阳性的乳腺癌患者应用不同疗程的卵巢功能抑制治疗(ovarian function suppression,OFS)时卵巢功能的评价作用。方法本研究为双向队列研究,研究的主要终点事件是OFS结束后月经的恢复、激素的变化。选取2015年5月至2019年5月期间在复旦大学附属肿瘤医院接受手术、化疗、OFS治疗24~60个月的绝经前激素受体阳性原发性乳腺癌67例患者为研究对象,因失访等因素剔除12例,最终纳入55例患者。根据完成OFS疗程的不同分为两组,分别为OFS 24个月疗程组(A组,n=32)、OFS 25~60个月疗程组(B组,n=23)。观察患者治疗后的月经恢复情况,检测完成OFS治疗后第1、第2、第3年患者AMH、促卵泡激素(follicle-stimulating hormone,FSH)和雌激素水平。结果两组患者随访时间为(42.0±12.3)个月,B组有1例患者复发转移,余均无复发转移,至随访结束全部患者生存。两组患者的年龄、身高、体质量、体质量指数(body mass index,BMI)、月经初潮年龄、病理类型、雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)阳性率、人表皮生长因子受体-2((human epidermal growth factor receptor-2,HER-2)阳性率、化疗与OFS治疗顺序的组间比较差异均无统计学意义(均P>0.05)。两组患者的孕次、产次、病理分级组间差异有统计学意义(P=0.013,P=0.028,P=0.025)。与B组比,A组月经恢复时间略长,复潮率略低,月经规律率略低,但差异均无统计学意义(均P>0.05)。OFS疗程结束后,第2年与第1年比较,AMH、FSH的变化差异有统计学意义(P=0.003,P=0.004),第3年与第2年比较,AMH、雌激素的变化差异有统计学意义(P=0.045,P=0.003);OFS疗程结束2、3年后AMH水平与结束1年后相比分别升高51.5%、72.1%,其中A组在疗程结束的第2、第3年的AMH水平与结束后第1年相比上升率分别是71.7%、101.9%,B组在疗程结束的第2、第3年�Objective To investigate the role of anti-Müllerian hormone(AMH)on the ovarian function evaluation in premenopausal breast cancer patients with hormone receptor positive after different courses of ovarian function suppression(OFS)treatment.Methods This study was a two-way cohort study.The main endpoints of the study were menstrual recovery and hormone changes after OFS treatment.Totally sixty-seven premenopausal breast cancer patients were enrolled,whose estrogen receptor(ER)and progesterone receptor(PR)had been tested positive from May 2015 to May 2019,and who had undergone operations,chemotherapies and OFS treatments for 24-60 months in Fudan University Shanghai Cancer Center.Twelve cases were eliminated because of missing tracking.The enrolled cases were divided into 2 groups according to OFS treatment,group A was treated with goserelin for 24 months(n=32),and group B,with goserelin for 25-60 months(n=23).Following the OFS treatment,the time points of menstrual recovery were observed and the serum levels of AMH,follicle-stimulating hormone(FSH)and estrogen(E2)levels were measured in the two groups.Results The follow-up period of the two groups was(42.0±12.3)months.All the patients survived their follow-ups,except one who developed recurrence and metastasis in the 25-60 month course of OFS.No significant differences were observed in age,height,weight,body mass index(BMI),menarche age,pathological type,pathological grade,ER,PR positive rate,human epidermal growth factor receptor-2(HER-2)positive rate,sequence of chemotherapy and OFS treatment between the two groups(all P>0.05).The time of menstruation recovery was longer in group A than in group B,the menstruation recovery rate became lower,and the regular rate of menstruation became lower,but there was no significant difference(all P>0.05).After the completion of OFS treatment,the change of AMH and FSH levels in the second year was significantly different from that in the first year(P=0.003,P=0.004),and the change of AMH and E2 levels was statistically differ

关 键 词：抗苗勒管激素 戈舍瑞林 乳腺肿瘤 卵巢功能抑制 

分 类 号：R737.9[医药卫生—肿瘤]