全身化学療法の卵巣機能への影響。プロスペクティブ臨床試験

The Effect of Systemic Chemotherapy on Ovarian Function: A Prospective Clinical Trial.

• Filiz Çelebi
• Çetin Ordu
• Serkan Ilgün
• Alper Oztürk
• Zeynep Erdoğan Iyigün
• Gül Alço
• Tomris Duymaz
• Fatma Aktepe
• Gürsel Soybir
• Bülent Baysal
• Vahit Özmen

抄録

目的:

乳がんの閉経前女性は，化学療法後に卵巣機能不全を発症するリスクがある．本研究の目的は，乳癌の閉経前女性における全身化学療法の卵巣機能への悪影響を調べることであった．

Objective: Premenopausal women with breast cancer are at risk of developing ovarian failure after chemotherapy. The aim of this study was to investigate the negative effects of systemic chemotherapy on ovarian function in premenoupausal women with breast cancer.

材料と方法:

26～48歳の手術可能な乳がんを有する閉経前女性31人が、予備的な結果を調べるためにこの前向きコホート研究に登録された。5回の測定がすべて終了した後、69人の患者のデータを追加登録する予定である。卵巣機能を評価するために、3 ヵ月間隔での血清アンチムリエリアンホルモン（AMH）値、平均卵巣容積（MOV）、肛門卵胞数（AFC）の変化を記録した。1年間の追跡期間中に少なくとも1回の治療前と4回の治療後の測定を行った女性を研究に含めた。化学療法レジメンの決定は腫瘍委員会によって行われた。

Materials and Methods: Thirty-one premenopausal women with operable breast cancer aged between 26-48 years were enrolled in this prospective cohort study to investigate preliminary results. Additional 69 patients' data will be included after the completion of all five measurements. The change in serum Antimullerian Hormone (AMH) levels, mean ovarian volumes (MOV) and antral follicle counts (AFCs) at 3-month intervals were recorded to evaluate ovarian function. Women who had at least one pretreatment and four post-treatment measurements in one year follow-up period were included in the study. Decision of chemotherapy regimen was taken by the Tumor Board.

結果:

31人の患者で、AMH、MOV、AFCの5つの結果がすべて得られた。追跡期間中の1～5AMHレベル（p=0.006）と1～5AFCの間には統計学的に有意な負の相関があった（p<0.0001）。しかし、化学療法前後のMOVの測定では、有意な相関は示されなかった（p=0.799）。BMI、パリティ、授乳、乳がんの病理組織学と分子サブタイプ、アルコール摂取量、喫煙、化学療法レジメンの種類は、AMH、AFCとMOVと有意な相関はありませんでした。

Results: Thirty-one patients had all five AMH, MOV and AFCs results. There was a statistically significant negative correlation between 1 - 5 AMH levels (p=0.006) and 1 - 5 AFCs during the follow-up period (p<0.0001). However pre- and post-chemotherapy measurements of MOVs did not demonstrate any significant correlation (p=0.799). BMI, parity, lactation, histopathology and molecular subtypes of breast cancer, alcohol intake, smoking and type of chemotherapy regimen were not significantly correlated with AMH, AFC and MOV.

結論:

治療前のAMHレベルとAFCは、化学療法後の卵巣予備能の早期予測に重要な役割を持つことが示された。

Conclusion: Pretreatment AMH levels and AFC were shown to have a significant role in early prediction of ovarian-reserve after chemotherapy.

Copyright © 2020 Turkish Federation of Breast Diseases Associations.