A prospective prognostic study of the hormonal milieu at the time of surgery in premenopausal breast carcinoma

BACKGROUND. Despite numerous studies, the influence of timing at surgery in relation to the menstrual cycle on the prognosis of breast carcinoma is st ill controversial, Most studies are retrospective, and the reliability of t he menstrual history data is limited by the lack of hormonal assessment at the time of surgery. The authors prospectively studied the influence of the menstrual cycle phase as determined by circulating hormones at the time of surgery on the outcome of breast carcinoma. METHODS. A population of 360 premenopausal women with nonmetastatic breast carcinoma operated on from 1992 to 1995 was analyzed. Serum estradiol, prog esterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels were assayed the day of surgery to define the menstrual cycle phase (follicular, n = 186; ovulatory, n = 24; luteal, n = 150). The mean follow- up was 48 months. RESULTS, There were no relations between the menstrual phase at surgery and tumor size, cathepsin D level, Scarff-Bloom-Richardson grade, Pg receptor (PgR), and the number of positive lymph nodes. The mean estrogen receptor l evel was higher during the follicular phase than in the ovulatory and lutea l phases (P < 0.02). Univariate analysis of recurrence free survival (RFS) and overall survival (OS) showed no relations with the menstrual phase or t he level of estradiol and progesterone at the time of surgery. High LH or F SH levels (above the medians) were associated with shorter RFS (P = 0.02 an d P = 0.04, respectively) or OS (P less than or equal to 0.01 and P = 0.01, respectively). in multivariate analysis, lymph node status, PgR status and LH level were the most significant parameters for predicting BS. There app eared to be no survival differences between menstrual cycle groups after st ratification by lymph node status. CONCLUSIONS. This prospective study showed a lack of prognostic value of ti ming at surgery in relation to the menstrual period or to estrogen and prog esterone levels in premenopausal breast carcinoma, Conversely, high gonadot ropin levels could predict OS independently of other prognostic factors. (C ) 2001 American Cancer Society.