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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

  • Yamazaki, Rena1
  • Inokuchi, Masafumi2
  • Ishikawa, Satoko3
  • Ayabe, Takuya4
  • Jinno, Hiromitsu4
  • Iizuka, Takashi1
  • Ono, Masanori1
  • Myojo, Subaru1
  • Uchida, Soko5
  • Matsuzaki, Toshiya6
  • Tangoku, Akira6
  • Kita, Masato7
  • Sugie, Tomoharu8
  • Fujiwara, Hiroshi1
  • 1 Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan , Kanazawa (Japan)
  • 2 Kanazawa Medical University, Kanazawa, Japan , Kanazawa (Japan)
  • 3 Kanazawa University Graduate School of Medical Science, Kanazawa, Japan , Kanazawa (Japan)
  • 4 Teikyo University School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 5 National Hospital Organization Fukuokahigashi Medical Center, Koga, Japan , Koga (Japan)
  • 6 Tokushima University, Takushima, Japan , Takushima (Japan)
  • 7 Kansai Medical University, Hirakata, Japan , Hirakata (Japan)
  • 8 Kansai Medical University Hospital, Hirakata, Japan , Hirakata (Japan)
Published Article
BMC Cancer
Springer (Biomed Central Ltd.)
Publication Date
Jan 29, 2020
DOI: 10.1186/s12885-020-6549-5
Springer Nature


BackgroundWe 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.MethodsPremenopausal 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.ResultsThe 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%).ConclusionsThese 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.

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