A Retrospective Study On Chemotherapy-induced Amenorrhea In Premenopausal Node-positive Women With Breast Cancer

Objective: The purpose of this study was observing the menstrual status of 144 premenopausal node-positive breast cancer patients treated with adjuvant chemotherapy,to explore the main factors contributing to chemotherapy-induced amenorrhea(CIA),and to evaluate the influence of CIA on the rate of 3-year DFS(disease-free survival).Searching chemotherapy treatment which had minor injury on ovary and evaluate the CIA on the effect prognosis of breast cancer,to provide certain theoretical basis for individualized treatment.Materials and Methods:1.We enrolled 512 premenopausal node-positive breast cancer patients by pathology diagnose who underwent radical mastectomy in the First Affiliated hospital of Dalian Medical University hospital from January 1st 2008 to January 31 st 2013.All patients were without distant metastasis,and had complete clinical data.2.185 patients left through a strict inclusion criteria and exclusion criteria.These data were recorded,including the patient's age,styles of surgery tumor size,number of lymph node metastasis,ER,PR,histology,differentiation of tumor,different chemotherapy treatment and cycles,endocrine treatment.,time of recurrence or distant metastasis and location of metastasis.Menstruation status,occurrence of CIA as well as recovery from CIA were recorded during and after the chemotherapy completion.All patient involved for the study is up to January 31 st 2016.185 patients were retrospectively analyzed to study the effect of CIA and the rate of 3-year-DFS(disease-free survival)3.Analysis were performed using SPSS 17.0.Chi-square test assessed the association between the categorical variables and CIA.Kaplan-Meier methods wereused to estimate PFS and Log-rank test was performed to establish the statistical significance.T test was used to estimate rate.Statistical significance was defined at P< 0.05.Results:1.Clinical characteristics:Of the 185 premenopausal node-positive breast cancer patients,the mean age is42.56,the youngest is 27 and the oldest is 53.The rate of CIA is 63.2% and 35.0%during the first month after chemotherapy treatment.2.Ages and CIA :(1)As age increases(<35,35-40,41-45,46-50,>50),the rate of CIA was higher(16.7%,34.8%,71.2%,89.1%,91.7%)(p<0.05).(2)The recovery rate from CIA was lower as age increases(66.7%,53.3%,31.9%,17.1%,0%).3.chemotherapy treatment and CIA:(1)Different chemotherapy regimen after radical mastectomy had different rates of CIA.The rates of CIA were 68.4% for the AC-T/AC-TH,51.9% for the CEF/CAF/AC regimen,and 65.7% for TA/TAC.(2)Significant difference in the rates of CIA were found between the AC-T/AC-TH and CEF/CAF/AC treatment group(P<0.05).No significant difference in the rates of CIA were found between the AC-T /AC-TH and TA/TAC treatment group(p=0.773),as well as CEF/CAF/AC and TA/TAC treatment group(p=0.208).4.Endocrine treatment and CIA:The rate of CIA receiving endocrine treatment and without endocrine treatment was 60.6%,70.8%(p=0.208).5.CIA and the rate of 3-year disease-free-survival :(1)During the follow up,DFS was 84.6% in CIA group and 72.1% in non-CIA group with a statistically significant difference(P<0.05).It is balanced with lymph node metastasis and hormone receptor situation in two groups.(2)In the hormone receptor-positive group,the rate of 3-year DFS was 83.5% in CIA group and 69.1% in non-CIA group with a statistically significant difference(P<0.05).In hormone receptor-negative group,the rate of 3-year DFS was 88.5% in CIA group and 84.6% in non-CIA group without statistically significant difference(P=0.735).Conclusions:1.Premenopausal node-positive women with breast cancer accepted adjuvant chemotherapy may damage ovarian function,even lead to amenorrhea.The regimens of anthracycline cyclophosphamide followed taxanes and three-drug combination regimens of cyclophosphamide,anthracycline,and taxanes(CAT)may cause higher rate of CIA.2.Elder patients got higher incidence of CIA,but the recovery from CIA was lower.There is significant difference between patients of age below 40 and above40.Ages below 40 may returning to menses easily.3.CIA may prelong disease-free survival in premenopausal node-positive patients.Also it may improve the rate of disease-free survival(DFS)with hormone receptor-positive premenopausal patients.