Randomized Controlled Trial

. 2024 Nov 5;26(1):152.

doi: 10.1186/s13058-024-01903-9.

Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy

Young Joo Lee¹, Woo Chul Noh², Sungchan Gwark³, Hyun-Ah Kim⁴, Jai Min Ryu⁵, Seung Il Kim⁶, Eun-Gyeong Lee⁷, Seock-Ah Im⁸, Yongsik Jung⁹, Min Ho Park¹⁰, Kyong Hwa Park¹¹, Su Hwan Kang¹², Joon Jeong¹³, Eunhwa Park¹⁴, Sung Yong Kim¹⁵, Min Hyuk Lee¹⁶, Lee Su Kim¹⁷, Woosung Lim³, Seonok Kim¹⁸, Hee Jeong Kim¹⁹

Affiliations

¹ Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
² Department of Surgery, Konkuk University Medical Center, Seoul, South Korea.
³ Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
⁴ Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea.
⁵ Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁶ Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
⁸ Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
⁹ Department of Surgery, School of Medicine, Ajou University, Suwon, South Korea.
¹⁰ Department of Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Gwangju, South Korea.
¹¹ Department of internal medicine, Division of Medical Oncology/Hematology, Korea University Anam Hospital, Seoul, South Korea.
¹² Yeungnam University College of Medicine, Daegu, South Korea.
¹³ Division of Breast Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
¹⁴ Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea.
¹⁵ Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea.
¹⁶ Department of Surgery, Soonchunhyang University Hospital, Seoul, South Korea.
¹⁷ Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
¹⁸ Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea.
¹⁹ Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. heejeong_kim@amc.seoul.kr.

PMID: 39501399
PMCID: PMC11539666
DOI: 10.1186/s13058-024-01903-9

Randomized Controlled Trial

Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy

Young Joo Lee et al. Breast Cancer Res. 2024.

. 2024 Nov 5;26(1):152.

doi: 10.1186/s13058-024-01903-9.

Authors

Affiliations

¹ Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
² Department of Surgery, Konkuk University Medical Center, Seoul, South Korea.
³ Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
⁴ Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea.
⁵ Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁶ Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
⁸ Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
⁹ Department of Surgery, School of Medicine, Ajou University, Suwon, South Korea.
¹⁰ Department of Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Gwangju, South Korea.
¹¹ Department of internal medicine, Division of Medical Oncology/Hematology, Korea University Anam Hospital, Seoul, South Korea.
¹² Yeungnam University College of Medicine, Daegu, South Korea.
¹³ Division of Breast Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
¹⁴ Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea.
¹⁵ Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea.
¹⁶ Department of Surgery, Soonchunhyang University Hospital, Seoul, South Korea.
¹⁷ Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea.
¹⁸ Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea.
¹⁹ Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. heejeong_kim@amc.seoul.kr.

PMID: 39501399
PMCID: PMC11539666
DOI: 10.1186/s13058-024-01903-9

Abstract

Background: Chemo-endocrine therapy can lead to various side effects associated with ovarian dysfunction. Predicting menstrual recovery is necessary to discuss the treatment-related issues regarding fertility and premature menopause with patients.

Methods: In the ASTRRA trial, patients who resumed ovarian function within 2 years after chemotherapy were randomized to receive tamoxifen for 5 years or OFS with tamoxifen for 2 years. With these 1298 patients, we developed a model that predicts when menstrual recovery will occur within a 3-year period after chemotherapy using variables including age, body mass index, chemotherapy regimen and duration, and serum estradiol and follicle-stimulating hormone levels.

Results: The data of 957 patients were used to develop the prediction model, and those of 341 patients were used for validation. In the development group, menstruation resumed in 450 patients (47.0%) within 5 years. In multivariable analysis, younger age (< 35 vs. 45, HR 7.85, 95% CI 4.63-13.30, p < 0.0001), anthracycline-based chemotherapy without taxane (vs. with taxane, HR 1.81, 95% CI 1.37-2.38, p < 0.0001), and chemotherapy duration (≤ 90 days vs. > 90 days, HR 1.32, 95% CI 1.01-1.72, p = 0.045) correlated with menstrual recovery. Using combined age, regimen, and duration of chemotherapy, we developed a simplified scoring system to estimate recovery chances and used a concordance index of 0.679 overall and 0.744 at 3 years for validation.

Conclusion: This model predicted timing and probability of menstrual recovery, based on their individual age, type and duration of chemotherapy in premenopausal women diagnosed with breast cancer who received tamoxifen after chemotherapy.

Keywords: Breast neoplasms; Chemotherapy; Menstruation; Premenopause; Tamoxifen.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
CONSORT flow diagram showing enrollment, and follow-up process with the respective patient numbers and reasons for exclusion

**Fig. 2**
Calibration curve for the prediction of menstrual recovery in all patients. (a) Internal validation with development set of patients enrolled in 2009–2011 (n = 957). (b) Validation with patients enrolled in 2012 and 2013 (n = 341)

See this image and copyright information in PMC

References

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Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy

Affiliations

Prediction of menstrual recovery patterns in premenopausal women with breast cancer taking tamoxifen after chemotherapy: an ASTRRA Substudy

Authors

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Abstract

Conflict of interest statement

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References

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