Consistency Analysis Of Serum Anti-mü Llerian Hormone,Estradiol And Follicle Stimulating Hormone On Menstrual Status Of Patients With Premenopausal Endocrine Therapy For Breast Cancer

Objective:To investigate the changes of serum anti-mullerian hormone(AMH)level in premenopausal endocrine therapy breast cancer patients and its consistency with estradiol(E2)and follicle-stimulating hormone(FSH)in menses state judgment,and to observe the adverse reactions of tamoxifen(TAM)endocrine therapy breast cancer patients with female reproductive system diseases.Methods:A diagnostic study was conducted from January 2019 to September 2019 in the breast surgery department of Mianyang central hospital,female patients with invasive ductal carcinoma who are undergoing TAM endocrine therapy and have stopped menstruation,including 16 patients diagnosed as menopausal according to CSCO guidelines(postmenopausal group)and 42 patients diagnosed as premenopausal according to CSCO guidelines(premenopausal group).The AMH,E2 and FSH values(expressed by AMH(1),E2(1),FSH(1)and AMH(2),E2(2),FSH(2),respectively)were measured twice continuously according to the postoperative reexamination time of the patients,and the gynecological color doppler ultrasound system examination was completed at the same time.The AMH values of breast cancer patients in postmenopausal and premenopausal groups were compared.And the difference of AMH value between the two times.The relationship between AMH values and menopausal status was analyzed.Looking for AMH cut off for judging menopausal status.The sensitivity,specificity,total coincidence rate,false positive rate and false negative rate for judging menopause under the AMH value were calculated.At the same time,the area under ROC curve(AUC)of AMH,E2 and FSH were calculated respectively,and the ability differences of single indexes of AMH,E2 and FSH to determine menopausal status were compared.In addition,according to the results of gynecologic color doppler ultrasound,the occurrence of side effects of reproductive system in postmenopausal and postmenopausal women was compared.Results:The AMH values of postmenopausal and postmenopausal breast cancer patients treated by TAM were statistically significant(P<0.001).AMH value in postmenopausal group was lower than that in premenopausal group.AMH<0.013 ng/ml is defined as the cut off for diagnosing menopause.AMH(1)has a sensitivity of 81.25%,specificity of 85.71%,total coincidence rate of 84.48%,false positive rate of 14.29%,and false negative rate of 18.75%.AMH(2)has a sensitivity of 93.75%,specificity of 80.95%,total coincidence rate of 84.48%,and false positive rate of 19.05%and false negative rate of6.25%.The area under ROC curve of AMH(1),AMH(2),E2(2)and FSH(2)was significantly different from the area under diagonal line of 0.5(p<0.05).AUC of AMH(2),AMH(1),FSH(2),E2(2)were 0.875(95%CI:0.784~0.966)?0.847(95%CI:0.744~0.951)?0.881(95%CI:0.794~0.968)?0.736(95%CI:0.611~0.861),respectively.The AUC of AMH(1)and AMH(2)were significantly different from E2(2)(P<0.001).There was no significant difference in the probability of side effects of female reproductive system between menopausal group and postmenopausal group during TAM treatment(?~2=0.728,p=0.394).However,the ratio of side effects of female reproductive system to no side effects of female reproductive system in non-menopausal group was 1.67 times that in menopausal group(OR=1.67),and these common side effects of female reproductive system include hysteromyoma,endometrial thickening,ovarian cyst(non-physiological).Conclusion:AMH value of postmenopausal patients was significantly lower than that of premenopausal patients in TAM endocrine therapy for breast cancer.AMH,E2 and FSH have good consistency in determining the menopausal status of premenopausal endocrine therapy breast cancer patients.Among breast cancer patients treated by TAM,the incidence of side effects of reproductive system diseases in postmenopausal women is higher than that in postmenopausal women.When serious adverse drug reactions occur in premenopausal endocrine therapy for breast cancer patients,AMH combined with E2 and FSH can be used to judge the menopausal status of the patients,so as to guide reasonable endocrine therapy decisions and improve the compliance of patients with endocrine therapy.