Publication: Fallo ovárico precoz quimioinducido en pacientes con cáncer de mama en edad reproductiva. Valor pronóstico de los estimadores de reserva ovárica
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2018-04-11
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Universidad Complutense de Madrid
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Abstract
ÁMBITO DEL ESTUDIO. Sección de Reproducción. Hospital General Universitario Gregorio Marañón. C/ Odonnel nº 39-40 28009 Madrid. OBJETIVO PRINCIPAL. Analizar el efecto de la reserva ovárica basal estimada por medio del recuento ecográfico de folículos antrales y de la concentración sérica de AMH, sobre el fallo ovárico clínico quimioinducido en pacientes en edad reproductiva con cáncer de mama tratadas con quimioterapia neoadyuvante o adyuvante. DISEÑO Estudio de cohortes prospectivo con análisis de supervivencia. MARCO CONCEPTUAL Y JUSTIFICACIÓN DEL ESTUDIO. El cáncer de mama es el tumor más frecuente en las mujeres del mundo occidental. Un 15% de estas mujeres se encuentran en edad reproductiva en el momento del diagnóstico, sin haber completado aun su deseo genésico. Un efecto colateral desfavorable de la quimioterapia es el fallo ovárico precoz, que produce en estas pacientes un estado postmenopáusico temporal o definitivo. A día de hoy, son escasos en la literatura los estudios prospectivos y centrados en mujeres con cáncer de mama en edad reproductiva, que evalúen los marcadores de reserva ovárica para el cálculo de la probabilidad de recuperación de la función ovárica tras la quimioterapia. Una evaluación más precisa e individual del riesgo de infertilidad quimioinducida sería de gran ayuda para mejorar la información, consejo y orientación de las pacientes con cáncer de mama y deseo reproductivo.OBJETIVOS: Principal: Evaluar la asociación de la reserva funcional ovárica y la utilidad pronóstica de sus principales estimadores –recuento de folículos antrales y AMH– en relación con la aparición de fallo ovárico clínico en pacientes premenopáusicas en edad reproductiva tratadas con quimioterapia por carcinoma epitelial de mama. Secundarios: Estimar la frecuencia de fallo ovárico oculto en pacientes afectadas por cáncer de mama expuestas a regímenes actuales de quimioterapia. Analizar la asociación de los estimadores de reserva ovárica clínicos, bioquímicos y ecográficos con el riesgo de aparición de fallo ovárico oculto quimioinducido. Analizar la asociación de los estimadores de reserva ovárica clínicos, bioquímicos y ecográficos con el riesgo de aparición de reducción severa de la reserva funcional ovárica, entiendo por tal la aparición de fallo ovárico oculto o clínico a lo largo del seguimiento...
SETTING. Reproduction Unit. Gregorio Marañon University Hospital. C/ O’Donnell nº 39-40 28009 Madrid. AIM. To assess the effect of chemotherapy on ovarian reserve in reproductive-aged breast cancer patients and to identify prognostic factors associated with ovarian failure. DESIGN. Prospective cohort study with a survival analysis. BACKGROUND. Breast cancer is one of the most frequently diagnosed malignancies in young women worldwide. Approximately 15% of women will develop breast cancer during their reproductive age, before their family plan is complete. One of the possible long-term adverse effects of chemotherapy regimens is premature ovarian failure, which can be temporal or definitive. Nowadays there are limited prospective studies, focusing on reproductive-aged breast cancer patients, evaluating ovarian reserve markers to predict the probability of ovarian function resumption after chemotherapy. More accurate and individualized assessment of risk of chemo-induced infertility could improve the information and advice given to breast cancer patients with reproductive desire. SPECIFIC OBJECTIVES. Main: To assess the association between pretreatment functional ovarian reserve and posterior development of premature ovarian failure, and to evaluate prognostic utility of its main markers – antral follicle count and antimullerian hormone- in reproductive-aged breast cancer patients exposed to chemotherapy. Secondary: To evaluate the occurrence of subclinical ovarian failure in breast cancer patients exposed to current chemotherapy regimens. To assess the association between ovarian reserve markers and the risk of developing chemo-induced subclinical ovarian failure. To assess the association between ovarian reserve markers and the risk of severe ovarian function impairment, defined as subclinical ovarian failure or definitive amenorrhea developed over the follow up period...
SETTING. Reproduction Unit. Gregorio Marañon University Hospital. C/ O’Donnell nº 39-40 28009 Madrid. AIM. To assess the effect of chemotherapy on ovarian reserve in reproductive-aged breast cancer patients and to identify prognostic factors associated with ovarian failure. DESIGN. Prospective cohort study with a survival analysis. BACKGROUND. Breast cancer is one of the most frequently diagnosed malignancies in young women worldwide. Approximately 15% of women will develop breast cancer during their reproductive age, before their family plan is complete. One of the possible long-term adverse effects of chemotherapy regimens is premature ovarian failure, which can be temporal or definitive. Nowadays there are limited prospective studies, focusing on reproductive-aged breast cancer patients, evaluating ovarian reserve markers to predict the probability of ovarian function resumption after chemotherapy. More accurate and individualized assessment of risk of chemo-induced infertility could improve the information and advice given to breast cancer patients with reproductive desire. SPECIFIC OBJECTIVES. Main: To assess the association between pretreatment functional ovarian reserve and posterior development of premature ovarian failure, and to evaluate prognostic utility of its main markers – antral follicle count and antimullerian hormone- in reproductive-aged breast cancer patients exposed to chemotherapy. Secondary: To evaluate the occurrence of subclinical ovarian failure in breast cancer patients exposed to current chemotherapy regimens. To assess the association between ovarian reserve markers and the risk of developing chemo-induced subclinical ovarian failure. To assess the association between ovarian reserve markers and the risk of severe ovarian function impairment, defined as subclinical ovarian failure or definitive amenorrhea developed over the follow up period...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Ginecología y Obstetricia, leída el 12/06/2017