title: Resumption or persistence of menstruation after cytotoxic chemotherapy is a prognostic factor for poor disease-free survival in premenopausal patients with early breast cancer.
abstract: BACKGROUND
  We investigated the relationship between resumption or persistence of menstruation after cytotoxic chemotherapy (RM) and disease-free survival (DFS) in premenopausal patients with early breast cancer.
  
  
  METHODS
  Medical records from 872 patients who received cytotoxic chemotherapy for stage I to III breast cancer were retrospectively reviewed.
  
  
  RESULTS
  The median patient age was 41 years (range, 21-54) and the median follow-up duration was 6.2 years (range, 0.7-10.4). Six hundred ninety-two patients (79.4%) were hormone receptor (HR) positive and the majority of these received tamoxifen therapy after completing chemotherapy. The chemotherapy-induced amenorrhea (CIA) rate was 76.7% (n = 669), and 51.8% (n = 452) experienced RM during the follow-up period. One hundred twenty-one (13.9%) patients had persistent menstruation without CIA. DFS was significantly affected by younger age at diagnosis (≤35 years) (P = 0.013), tumor size > 2 cm (P < 0.001), node positivity (P < 0.001), HR negativity (P < 0.001), HER2 positivity (P = 0.010), and RM (P < 0.001). HR negativity [hazard ratio 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.006], tumor size > 2 cm (hazard ratio 2.1, 95% CI 1.4-3.0, P < 0.001), node positivity (hazard ratio 3.0, 95% CI 2.0-4.7, P < 0.001), and RM (hazard ratio 1.8, 95% CI 1.2-2.7, P = 0.004) remained significant factors for DFS on multivariate analysis.
  
  
  CONCLUSIONS
  A considerable proportion of premenopausal patients treated with chemotherapy experienced RM after CIA. RM was a poor prognostic factor for DFS in premenopausal patients with early breast cancer.
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: I H
authors.initials: IH
authors.lastname: Park
authors.affiliation: Department of Internal medicine, Chungbuk College of Medicine, Chungbuk.
authors.forename: H S
authors.initials: HS
authors.lastname: Han
authors.affiliation: Center for Clinical Trial, National Cancer Center, Goyang, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: K S
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: H S
authors.initials: HS
authors.lastname: Kang
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang.
authors.forename: S
authors.initials: S
authors.lastname: Jung
authors.affiliation: Center for Breast Cancer, National Cancer Center, Goyang. Electronic address: jungsro@ncc.re.kr.
authors.forename: J
authors.initials: J
authors.lastname: Ro
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D000069287:Capecitabine; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D053208:Kaplan-Meier Estimate; D008597:Menstrual Cycle / Q000187:drug effects*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D017697:Premenopause; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D000069287:Capecitabine; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate