TY - JOUR
T1 - Ovarian reserve after chemotherapy in breast cancer: A systematic review and meta-analysis
AU - Romito, Alessia
AU - Romito, Luigi Michele Antonio
AU - Bove, Sonia
AU - Romito, Ilaria
AU - Zace, Drieda
AU - Raimondo, Ivano
AU - Fragomeni, Simona Maria
AU - Rinaldi, Pierluigi Maria
AU - Pagliara, Domenico
AU - Lai, Antonella
AU - Lai, Alessandro
AU - Marazzi, Fabio
AU - Marchetti, Claudia
AU - Paris, Ida
AU - Franceschini, Gianluca
AU - Masetti, Riccardo
AU - Scambia, Giovanni
AU - Fabi, Alessandra
AU - Garganese, Giorgia
PY - 2021
Y1 - 2021
N2 - Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of -1.97 (95% CI: -3.12, -0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
AB - Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of -1.97 (95% CI: -3.12, -0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.
KW - AMH
KW - Breast cancer
KW - Chemotherapy
KW - Ovarian reserve
KW - Pregnancy desire
KW - AMH
KW - Breast cancer
KW - Chemotherapy
KW - Ovarian reserve
KW - Pregnancy desire
UR - http://hdl.handle.net/10807/190395
U2 - 10.3390/jpm11080704
DO - 10.3390/jpm11080704
M3 - Article
SN - 2075-4426
VL - 11
SP - 1
EP - 14
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
ER -
