Ovarian hyperstimulation closely associated with resumption of follicular growth after chemotherapy during tamoxifen treatment in premenopausal women with breast cancer: a multicenter retrospective cohort study
Rena Yamazaki,
Masafumi Inokuchi,
Satoko Ishikawa,
Takuya Ayabe,
Hiromitsu Jinno,
Takashi Iizuka,
Masanori Ono,
Subaru Myojo,
Soko Uchida,
Toshiya Matsuzaki,
Akira Tangoku,
Masato Kita,
Tomoharu Sugie,
Hiroshi Fujiwara
Affiliations
Rena Yamazaki
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science
Masafumi Inokuchi
Department of Breast and Endocrine Surgery, Kanazawa Medical University
Satoko Ishikawa
Department of Breast Oncology, Division of Cancer Medicine, Kanazawa University Graduate School of Medical Science
Takuya Ayabe
Department of Obstetrics and Gynecology, Teikyo University School of Medicine
Hiromitsu Jinno
Department of Surgery, Teikyo University School of Medicine
Takashi Iizuka
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science
Masanori Ono
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science
Subaru Myojo
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science
Soko Uchida
Department of Gynecology, National Hospital Organization Fukuokahigashi Medical Center
Toshiya Matsuzaki
Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Tokushima University
Akira Tangoku
Department of Thoracic, Endocrine Surgery and Oncology, Graduate School of Biomedical Sciences, Tokushima University
Masato Kita
Department of Obstetrics and Gynecology, Kansai Medical University
Tomoharu Sugie
Department of Breast Surgery, Kansai Medical University Hospital
Hiroshi Fujiwara
Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science
Abstract Background We previously reported that tamoxifen (TAM)-induced ovarian hyperstimulation (OHS) is associated with high serum concentrations of estradiol in premenopausal women with breast cancer. To investigate risk factors for TAM-induced OHS, we performed a retrospective multicenter study. Methods Premenopausal patients who received surgical therapy for endocrine-dependent breast cancer (n = 235) were recruited in this study and classified into 4 groups: group A, treated with TAM alone; group B, TAM treatment after 2-year-combined therapy with a gonadotropin-releasing hormone (Gn-RH) agonist; group C, TAM treatment after chemotherapy; group D, 5-year-combined therapy with TAM and a Gn-RH agonist. A serum estradiol value of more than 300 pg/mL or mean follicular diameter of more than 30 mm was defined as OHS. Results The incidence of OHS in group A (n = 13/26, 50.0%) was significantly higher than those in group B (n = 17/63, 27.0%), group C (n = 20/110, 18.2%), and group D (n = 0/36, 0%). The incidence of OHS was significantly correlated with aging, and the median serum concentration of estradiol in the presence of OHS was 823.0 pg/mL. The incidence of OHS (less than 47 years old) was 62.5% in group A, 48.6% in group B, and 28.2% in group C, respectively. Notably, the incidence rate of OHS following amenorrhea in group C (n = 13/20, 65.0%) was significantly higher than that in group B (n = 1/17, 5.9%). Conclusions These findings indicate that the onset of OHS following amenorrhea was common in the post-chemotherapeutic group, while its ratio was low in the group after Gn-RH analog treatment, suggesting that combined treatment-based management involving TAM therapy is necessary for premenopausal patients with breast cancer.
