Predicting Ovarian Activity in Women Affected by Early Breast Cancer: A Meta-Analysis-Based Nomogram.
BACKGROUND
The assessment of ovarian reserve in premenopausal women requiring anticancer gonadotoxic therapy can help clinicians address some challenging issues, including the probability of future pregnancies after the end of treatment. Anti-Müllerian hormone (AMH) and age can reliably estimate ovarian reserve. A limited number of studies have evaluated AMH and age as predictors of residual ovarian reserve following cytotoxic chemotherapy in breast cancer patients.


METHODS
To conduct a meta-analysis of published data on this topic, we searched the medical literature using the key MeSH terms "amenorrhea/chemically induced," "ovarian reserve," "anti-Mullerian hormone/blood," and "breast neoplasms/drug therapy." Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements guided the search strategy. U.K. National Health Service guidelines were used in abstracting data and assessing data quality and validity. Area under the receiver operating characteristic curve (ROC/AUC) analysis was used to evaluate the predictive utility of baseline AMH and age model.


RESULTS
The meta-analysis of data pooled from the selected studies showed that both age and serum AMH are reliable predictors of post-treatment ovarian activity in breast cancer patients. Importantly, ROC/AUC analysis indicated AMH was a more reliable predictor of post-treatment ovarian activity in patients aged younger than 40 years (0.753; 95% confidence interval [CI]: 0.602-0.904) compared with those older than 40 years (0.678; 95% CI: 0.491-0.866). We generated a nomogram describing the correlations among age, pretreatment AMH serum levels, and ovarian activity at 1 year from the end of chemotherapy.


CONCLUSIONS
After the ongoing validation process, the proposed nomogram may help clinicians discern premenopausal women requiring cytotoxic chemotherapy who should be considered high priority for fertility preservation counseling and procedures.
Endocrinology Unit, "Regina Elena" National Cancer Institute of Rome, Rome, Italy.
Agnese
A
Barnabei
Laboratory of Medical Physics and Expert Systems, "Regina Elena" National Cancer Institute of Rome, Rome, Italy.
Lidia
L
Strigari
Department of Clinical and Molecular Medicine, Medical Oncology Division, "Sapienza" University of Rome, Rome, Italy Sant'Andrea Hospital, Rome, Italy IDI-IRCCS, Rome, Italy.
Paolo
P
Marchetti
Department of Clinical and Molecular Medicine, Medical Oncology Division, "Sapienza" University of Rome, Rome, Italy Oncology Unit, "Santo Spirito" Hospital - Lungotevere in Sassia, Rome, Italy.
Valentina
V
Sini
Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy.
Liana
L
De Vecchis
Endocrinology Unit, Università Cattolica Roma, Rome, Italy corsello.sm@mclink.it.
Salvatore Maria
SM
Corsello
Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy.
Francesco
F
Torino
D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000139:chemically induced; D054304:Anti-Mullerian Hormone / Q000097:blood; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D049451:Nomograms; D065851:Ovarian Reserve / Q000502:physiology; D010053:Ovary / Q000187:drug effects* / Q000502:physiology*; D012372:ROC Curve
D000970:Antineoplastic Agents; D054304:Anti-Mullerian Hormone
Anti-Müllerian hormone; Breast cancer; Ovarian reserve; Ovarian toxicity; Predictive factors