Ramesh Omranipour
1,2,3 
, Fatemeh Ahmadi-Harchegani
4 , Azin Saberi
5 , Ashraf Moini
1,6,7 , Mostafa Shiri
8 , Amirmohsen Jalaeefar
2 , Arvin Arian
9 , Akram Seifollahi
10 , Mahshad Madani
11 , Bita Eslami
1* , Sadaf Alipour
1,5* 1 Breast Diseases Research Center (BDRC), Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Oncologic Surgery, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3 Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran
4 Department of Biostatistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Surgery, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
6 Department of Infertility, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
7 Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
8 Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran
9 Department of Radiology, Cancer Institute, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Tehran, Iran
10 Department of Pathology, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
11 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Breast cancer (BC) treatment decreases fertility capacity, but unnecessary fertility preservation procedures in women who would not be infertile after treatment would be a waste of time and resources and could cause the unwarranted exposure of cancer cells to exogenous sex hormones. It has been largely shown that post-treatment ovarian reserve is directly associated with pre-treatment anti-mullerian hormone levels (AMH0). A threshold for AMH0, or a model including AMH0 and patient characteristics that could distinguish the patients who will be infertile after treatments, still needs to be defined. Accordingly, this study was performed to specifically target this high-priority concern.
Methods: Women≤45 years old with newly diagnosed non-metastatic BC were entered in this multicenter prospective cohort study. AMH0 and two-year post-treatment AMH (AMH2) were measured, and hormonal patient features were recorded as well. Receiver operating characteristic (ROC) curve analysis, decision tree (DT), and random forest analyses were performed to find a cut-off point for AMH0 and define a model involving related features for the prediction of AMH2.
Results: The data from 84 patients were analyzed. ROC curve analysis revealed that AMH0>3 ng/mL (Area under the curve=0.69, 95% CI: 0.54‒0.84) was the best indicator for predicting AMH2≥0.7 (sensitivity=79%, specificity=60%). The best model detected by DT and random forest for predicting an AMH2>0.7 with a probability of 93% consisted of a combination of AMH0>3.3, menarche age<14, and age<31.
Conclusion: This combination model can be used to withhold fertility preservation procedures in BC patients. Performing larger studies is suggested to further test this model.