这项研究旨在探讨血液标志物在预测接受生育力保留(FP)的乳腺癌患者控制性卵巢刺激(COS)结局中的可用性。总的来说,在一家三级医院回顾性研究了91例乳腺癌患者,这些患者在化疗前使用来曲唑联合促性腺激素释放激素(GnRH)拮抗剂方案进行了COS。FP结果根据平均血小板体积(MPV)进行比较,MPV/血小板计数(PC),中性粒细胞与淋巴细胞比率(NLR),血小板与淋巴细胞比率(PLR),和淋巴细胞与单核细胞比率(LMR)。获得10个或更多成熟卵母细胞的截止值作为有利的预后获得了每个参数,并根据截止值比较COS结局.MPV和MPV/PC的最佳截止水平为10.15[灵敏度:90.0%;特异性:45.1%;AUC:0.687;95%CI(0.563,0.810)]和0.41[灵敏度:65.0%;特异性:67.6%;AUC:0.682;95%CI(0.568,0.796)],分别。卵母细胞数量与NLR的截止值没有显着差异,PLR,和LMR(p>0.05)。然而,MPV<10.15组的获得性和成熟卵母细胞总数明显低于MPV≥10.15组(8.0±5.1vs.12.6±9.1,p=0.003;4.0±3.7vs.7.3±6.3,p=0.002)。同样,考虑MPV/PC的临界值为0.41,低MPV/PC组的总卵母细胞产量明显低于高MPV/PC组(9.5±7.1vs.13.1±9.1,p=0.048),而成熟卵母细胞的数量显示出相似的模式,没有统计学意义(5.3±5.4vs.7.3±6.1,p=0.092)。从逻辑回归分析,年龄,抗苗勒管激素(AMH)水平,MPV,发现MPV/PC≥0.41是获得10个或更多MII卵母细胞的重要因素(分别为p=0.049,OR:0.850;p<0.001,OR:1.622;p=0.018,OR:3.184;p=0.013,OR:9.251)。MPV或MPV/PC可以是预测乳腺癌患者FP预后的可靠标志物。获得更多成熟卵母细胞的方案,例如双触发方法,可推荐MPV<10.15的乳腺癌患者。此外,在MPV/PC<0.41的患者中,更高剂量的促性腺激素被认为可获得更多的卵母细胞.
This study aimed to investigate the usability of blood markers for predicting controlled ovarian stimulation (COS) outcomes in patients with breast cancer undergoing fertility preservation (FP). In total, 91 patients with breast cancer who had undergone COS using a letrozole-combined gonadotropin-releasing hormone (GnRH) antagonist protocol before chemotherapy were enrolled retrospectively in a single tertiary hospital. FP outcomes were compared in terms of the mean platelet volume (MPV), MPV/platelet count (PC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). The cutoff values for obtaining 10 or more mature oocytes as favorable prognoses were obtained for each parameter, and the COS outcomes were compared based on the cutoff values. The optimal cutoff levels for MPV and MPV/PC were 10.15 [sensitivity: 90.0%; specificity: 45.1%; AUC: 0.687; 95% CI (0.563, 0.810)] and 0.41 [sensitivity: 65.0%; specificity: 67.6%; AUC: 0.682; 95% CI (0.568, 0.796)], respectively. The oocyte numbers did not significantly differ with respect to the cutoff values of NLR, PLR, and LMR (p > 0.05). However, the total number of acquired and mature oocytes were significantly lower in the group with MPV<10.15 than in that with MPV≥10.15 (8.0 ± 5.1 vs. 12.6 ± 9.1, p=0.003; 4.0 ± 3.7 vs. 7.3 ± 6.3, p=0.002, respectively). Similarly, considering the cutoff of MPV/PC as 0.41, the low-MPV/PC group showed a significantly lower total oocyte yield than the high-MPV/PC group (9.5 ± 7.1 vs. 13.1 ± 9.1, p=0.048), whereas the number of mature oocytes showed similar patterns with no statistical significance (5.3 ± 5.4 vs. 7.3 ± 6.1, p=0.092). From logistic regression analysis, age, anti-Müllerian hormone (AMH) level, MPV, and MPV/PC≥0.41 were found to be significant factors for the acquisition of 10 or more MII oocytes (p=0.049, OR: 0.850; p<0.001, OR: 1.622; p=0.018, OR: 3.184; p=0.013, OR: 9.251, respectively). MPV or MPV/PC can be a reliable marker for predicting FP outcome in patients with breast cancer. Protocols to acquire more mature oocytes, such as the dual-trigger approach, could be recommended for patients with breast cancer with MPV<10.15. Furthermore, a higher dose of gonadotropins was considered to obtain more oocytes in patients with MPV/PC<0.41.