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Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis

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)...

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Autores principales: Romito, Alessia, Bove, Sonia, Romito, Ilaria, Zace, Drieda, Raimondo, Ivano, Fragomeni, Simona Maria, Rinaldi, Pierluigi Maria, Pagliara, Domenico, Lai, Antonella, Marazzi, Fabio, Marchetti, Claudia, Paris, Ida, Franceschini, Gianluca, Masetti, Riccardo, Scambia, Giovanni, Fabi, Alessandra, Garganese, Giorgia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400427/
https://www.ncbi.nlm.nih.gov/pubmed/34442350
http://dx.doi.org/10.3390/jpm11080704
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author Romito, Alessia
Bove, Sonia
Romito, Ilaria
Zace, Drieda
Raimondo, Ivano
Fragomeni, Simona Maria
Rinaldi, Pierluigi Maria
Pagliara, Domenico
Lai, Antonella
Marazzi, Fabio
Marchetti, Claudia
Paris, Ida
Franceschini, Gianluca
Masetti, Riccardo
Scambia, Giovanni
Fabi, Alessandra
Garganese, Giorgia
author_facet Romito, Alessia
Bove, Sonia
Romito, Ilaria
Zace, Drieda
Raimondo, Ivano
Fragomeni, Simona Maria
Rinaldi, Pierluigi Maria
Pagliara, Domenico
Lai, Antonella
Marazzi, Fabio
Marchetti, Claudia
Paris, Ida
Franceschini, Gianluca
Masetti, Riccardo
Scambia, Giovanni
Fabi, Alessandra
Garganese, Giorgia
author_sort Romito, Alessia
collection PubMed
description 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.
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spelling pubmed-84004272021-08-29 Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis Romito, Alessia Bove, Sonia Romito, Ilaria Zace, Drieda Raimondo, Ivano Fragomeni, Simona Maria Rinaldi, Pierluigi Maria Pagliara, Domenico Lai, Antonella Marazzi, Fabio Marchetti, Claudia Paris, Ida Franceschini, Gianluca Masetti, Riccardo Scambia, Giovanni Fabi, Alessandra Garganese, Giorgia J Pers Med Systematic Review 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. MDPI 2021-07-23 /pmc/articles/PMC8400427/ /pubmed/34442350 http://dx.doi.org/10.3390/jpm11080704 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Romito, Alessia
Bove, Sonia
Romito, Ilaria
Zace, Drieda
Raimondo, Ivano
Fragomeni, Simona Maria
Rinaldi, Pierluigi Maria
Pagliara, Domenico
Lai, Antonella
Marazzi, Fabio
Marchetti, Claudia
Paris, Ida
Franceschini, Gianluca
Masetti, Riccardo
Scambia, Giovanni
Fabi, Alessandra
Garganese, Giorgia
Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title_full Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title_fullStr Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title_full_unstemmed Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title_short Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis
title_sort ovarian reserve after chemotherapy in breast cancer: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400427/
https://www.ncbi.nlm.nih.gov/pubmed/34442350
http://dx.doi.org/10.3390/jpm11080704
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