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Pretreatment anti-Mullerian hormone-based nomogram predicts menstruation status after chemotherapy for premenopausal women with hormone receptor-positive early breast cancer

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Abstract

Purpose

Ovarian function is important for optimizing endocrine treatment in patients with hormone receptor-positive (HR+) early breast cancer (eBC). The aim of the study was to determine whether patients’ pretreatment levels of anti-Mullerian hormone (AMH) were associated with menses status after chemotherapy and to build a predictive nomogram model for amenorrhea in women with HR+ eBC.

Methods

Between August 2013 and December 2014, 120 premenopausal patients with HR+ eBC were included retrospectively. The associations among age, prechemotherapy levels of AMH, follicle-stimulating hormone (FSH),and estradiol (E2) and the 2-year postchemotherapy menses status were analyzed. We determined the cutoff values of hormone levels by using the biostatistical tool (Cutoff Finder). A novel nomogram was established to predict the 2-year amenorrhea status based on the logistic analysis. Concordance index (C-index) was used to validate the capacity.

Results

One hundred nine women (90.8%) experienced amenorrhea after chemotherapy. AMH < 0.965 ng/ml predicted amenorrhea at 2 years (AUC 0.84, sensitivity 74% and specificity 81.8%), independent of age. The predictive nomogram based on age and pretreatment AMH and FSH levels was developed to predict the probability of 2-year postchemotherapy amenorrhea with a C-index of 0.88 (95% CI 0.84–0.91).

Conclusions

In premenopausal patients with HR+ eBC, prechemotherapy AMH concentration was associated with the patient’s 2-year amenorrhea status, independent of age. The nomogram model based on age and pretreatment AMH and FSH levels accurately predicted the 2-year amenorrhea status.

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Funding

This study was supported by Grants from the International Collaboration Foundation of Science and Technology Planning Project of Guangdong Province of China (2016A050502015), the National Natural Science Foundation of China (81773279), and the Fundamental Research Funds for the Central Universities (17ykzd33). The funder had no role in study design, analysis, or decision to publish.

Author information

Author notes

  1. Cong Xue, Wenwen Wei, Ruhai Zou and Yanxia Shi contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Dongfeng Road East 651#, Guangzhou, 510060, China

    Cong Xue, Wenwen Wei, Peng Sun, Xiaoju Diao, Fei Xu, Jiajia Huang, Xin An, Wen Xia, Ruoxi Hong, Kuikui Jiang, Riqing Huang, Zhongyu Yuan, Shusen Wang & Yanxia Shi

  2. Department of Ultrasound and Electrocardiogram, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China

    Wei Zheng, Anhua Li & Ruhai Zou

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  1. Cong Xue
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  3. Peng Sun
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Corresponding author

Correspondence to Yanxia Shi.

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The authors declare that they have no conflict of interest.

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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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It was obtained from all individual participants included in the study.

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Cite this article

Xue, C., Wei, W., Sun, P. et al. Pretreatment anti-Mullerian hormone-based nomogram predicts menstruation status after chemotherapy for premenopausal women with hormone receptor-positive early breast cancer. Breast Cancer Res Treat 173, 619–628 (2019). https://doi.org/10.1007/s10549-018-4997-2

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