World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 2, April 2025, pages 200-209

Patterns, Predictors, and Prognostic Implication of Treatment-Related Amenorrhea in Patients With Breast Cancer

↓ Figure 1. Kaplan-Meier survival curves for the overall cohort and for comparing patients according to their TRA status. (a) Kaplan-Meier curve for the overall cohort. (b) Kaplan-Meier curves comparing survival of patients with EA to patients without EA. (c) Kaplan-Meier survival curves comparing survival of patients with LA to patients without LA. TRA: treatment-related amenorrhea; EA: early amenorrhea; LA: late amenorrhea.

↓ **Table 1.** Subject Demographics and Clinical Characteristics
Variables	Frequency n (%)
ER: estrogen receptor; PR: progesterone receptor; BMI: body mass index; WHO: World Health Organization; SD: standard deviation.
Age, years (median)	45.4	42.9	42.1	46.6
≤ 45	45 (55.6)	10 (71.4)	35 (52.2)	18 (40.0)
> 45	36 (44.4)	4 (28.6)	32 (47.8)	27 (60.0)
Parity
≤ 1	24 (29.6)	0 (0.0)	24 (35.8)	17 (37.8)
> 1	57 (70.4)	14 (100.0)	43 (64.2)	28 (62.2)
Stage
I-III	65 (80.2)	9 (64.3)	56 (83.6)	42 (93.3)
IV	16 (19.8)	5 (35.7)	11 (16.4)	3 (6.7)
ER status
Negative	26 (32.1)	6 (42.9)	20 (29.9)	9 (20.0)
Positive	55 (67.9)	8 (57.1)	47 (70.1)	36 (80.0)
PR status
Negative	35 (43.2)	6 (42.9)	29 (43.3)	15 (33.3)
Positive	46 (56.8)	8 (57.1)	38 (56.7)	30 (66.7)
BMI (WHO Asia-Pacific) (mean ± SD)	23.5 ± 4.7	23.3 ± 5.7	24.1 ± 4.1	23.3 ± 4.4
Obese	25 (30.9)	6 (42.9)	19 (28.4)	13 (28.9)
Overweight	16 (19.8)	3 (21.4)	13 (19.4)	9 (20.0)
Normal	32 (39.5)	4 (28.6)	28 (41.8)	19 (42.2)
Underweight	8 (9.9)	1 (7.1)	7 (10.4)	4 (8.9)
Radiotherapy
No	22 (27.2)	7 (50.0)	16 (23.9)	7 (15.6)
Yes	59 (72.8)	7 (50.0)	51 (76.1)	38 (84.4)
Number of chemotherapy cycles
< 8	30 (37.0)	9 (64.3)	21 (31.3)	12 (26.7)
≥ 8	51 (63.0)	5 (35.7)	46 (68.7)	33 (73.3)
Anthracycline-taxane regimen
No	72 (88.9)	13 (92.9)	59 (88.1)	39 (86.7)
Yes	9 (11.1)	1 (7.1)	8 (11.9)	6 (13.3)
Hormonal therapy
No	29 (35.8)	8 (57.1)	21 (31.3)	9 (20.0)
Yes	52 (64.2)	6 (42.9)	46 (68.7)	36 (80.0)

↓ Table 1. Subject Demographics and Clinical Characteristics

Variables

Frequency n (%)

All

No amenorrhea

Amenorrhea

Early amenorrhea (≥ 6 months)

Late amenorrhea (≥ 12 months)

ER: estrogen receptor; PR: progesterone receptor; BMI: body mass index; WHO: World Health Organization; SD: standard deviation.

Age, years (median)

45.4

42.9

42.1

46.6

≤ 45

45 (55.6)

10 (71.4)

35 (52.2)

18 (40.0)

> 45

36 (44.4)

4 (28.6)

32 (47.8)

27 (60.0)

Parity

≤ 1

24 (29.6)

0 (0.0)

24 (35.8)

17 (37.8)

> 1

57 (70.4)

14 (100.0)

43 (64.2)

28 (62.2)

Stage

I-III

65 (80.2)

9 (64.3)

56 (83.6)

42 (93.3)

16 (19.8)

5 (35.7)

11 (16.4)

3 (6.7)

ER status

Negative

26 (32.1)

6 (42.9)

20 (29.9)

9 (20.0)

Positive

55 (67.9)

8 (57.1)

47 (70.1)

36 (80.0)

PR status

Negative

35 (43.2)

6 (42.9)

29 (43.3)

15 (33.3)

Positive

46 (56.8)

8 (57.1)

38 (56.7)

30 (66.7)

BMI (WHO Asia-Pacific) (mean ± SD)

23.5 ± 4.7

23.3 ± 5.7

24.1 ± 4.1

23.3 ± 4.4

Obese

25 (30.9)

6 (42.9)

19 (28.4)

13 (28.9)

Overweight

16 (19.8)

3 (21.4)

13 (19.4)

9 (20.0)

Normal

32 (39.5)

4 (28.6)

28 (41.8)

19 (42.2)

Underweight

8 (9.9)

1 (7.1)

7 (10.4)

4 (8.9)

Radiotherapy

22 (27.2)

7 (50.0)

16 (23.9)

7 (15.6)

Yes

59 (72.8)

7 (50.0)

51 (76.1)

38 (84.4)

Number of chemotherapy cycles

< 8

30 (37.0)

9 (64.3)

21 (31.3)

12 (26.7)

≥ 8

51 (63.0)

5 (35.7)

46 (68.7)

33 (73.3)

Anthracycline-taxane regimen

72 (88.9)

13 (92.9)

59 (88.1)

39 (86.7)

Yes

9 (11.1)

1 (7.1)

8 (11.9)

6 (13.3)

Hormonal therapy

29 (35.8)

8 (57.1)

21 (31.3)

9 (20.0)

Yes

52 (64.2)

6 (42.9)

46 (68.7)

36 (80.0)

↓ Table 2. Sociodemographic and Clinical Factors Associated With Early Amenorrhea After Breast Cancer Treatment

Variables

Crude OR (95% CI)

Adjusted OR (95% CI)

OR: odds ratio; CI: confidence interval; Ref: reference; ER: estrogen receptor; PR: progesterone receptor; BMI: body mass index; WHO: World Health Organization; SD: standard deviation; Inf: infinity.

Age, years

≤ 45

Ref

> 45

2.29 (0.65 - 8.02)

0.197

2.44 (0.63 - 9.46)

0.196

Parity

≤ 1

Ref

> 1

0 (0 - Inf)

0.993

Stage

I-III

Ref

0.35 (0.10 - 1.26)

0.109

ER status

Negative

Ref

Positive

1.76 (0.54 - 5.74)

0.347

PR status

Negative

Ref

Positive

0.98 (0.31 - 3.15)

0.977

BMI (WHO Asia-Pacific) (mean ± SD)

Obese

Ref

Overweight

1.37 (0.29 - 6.48)

0.693

Normal

2.21 (0.55 - 8.90)

0.264

Underweight

2.21 (0.22 - 21.78)

0.497

Radiotherapy

Ref

Yes

3.19 (0.97 - 10.46)

0.056

2.20 (0.62 - 7.88)

0.224

Number of chemotherapy cycles

< 8

Ref

≥ 8

3.94 (1.18 - 13.21)

0.026

3.37 (0.93 - 12.24)

0.065

Anthracycline-taxane regimen

Ref

Yes

1.76 (0.20 - 15.34)

0.608

Hormonal therapy

Ref

Yes

2.92 (0.90 - 9.48)

0.074

2.10 (0.60 - 7.37)

0.249

↓ **Table 3.** Sociodemographic and Clinical Factors Associated With Late Amenorrhea After Breast Cancer Treatment
Variables	Crude OR (95% CI)	P	Adjusted OR (95% CI)	P
*P < 0.05. OR: odds ratio; CI: confidence interval; Ref: reference; ER: estrogen receptor; PR: progesterone receptor; BMI: body mass index; WHO: World Health Organization; SD: standard deviation.
Age, years
≤ 45	Ref		Ref
> 45	4.50 (1.72 - 11.77)	0.002	4.00 (1.23 - 13.01)	0.021*
Parity
≤ 1	Ref		Ref
> 1	0.40 (0.14 - 1.10)	0.077	0.52 (0.15 - 1.79)	0.298
Stage
I-III	Ref		Ref
IV	0.13 (0.03 - 0.49)	0.003	0.20 (0.04 - 0.90)	0.036*
ER status
Negative	Ref
Positive	3.58 (1.34 - 9.54)	0.011
PR status
Negative	Ref
Positive	2.50 (1.01 - 6.17)	0.047
BMI (WHO Asia-Pacific) (mean ± SD)
Obese	Ref
Overweight	1.19 (0.34 - 4.19)	0.790
Normal	1.35 (0.47 - 3.88)	0.578
Underweight	0.92 (0.19 - 4.54)	0.922
Radiotherapy
No	Ref
Yes	1.06 (0.40 - 2.83)	0.911
Number of chemotherapy cycles
< 8	Ref		Ref
≥ 8	2.75 (1.09 - 6.96)	0.033	2.66 (0.85 - 8.35)	0.094
Anthracycline-taxane regimen
No	Ref
Yes	1.69 (0.39 - 7.30)	0.480
Hormonal therapy
No	Ref		Ref
Yes	5.00 (1.87 - 13.36)	0.001	4.96 (1.58 - 15.53)	0.006*

↓ Table 3. Sociodemographic and Clinical Factors Associated With Late Amenorrhea After Breast Cancer Treatment

Variables

Crude OR (95% CI)

Adjusted OR (95% CI)

*P < 0.05. OR: odds ratio; CI: confidence interval; Ref: reference; ER: estrogen receptor; PR: progesterone receptor; BMI: body mass index; WHO: World Health Organization; SD: standard deviation.

Age, years

≤ 45

Ref

> 45

4.50 (1.72 - 11.77)

0.002

4.00 (1.23 - 13.01)

0.021*

Parity

≤ 1

Ref

> 1

0.40 (0.14 - 1.10)

0.077

0.52 (0.15 - 1.79)

0.298

Stage

I-III

Ref

0.13 (0.03 - 0.49)

0.003

0.20 (0.04 - 0.90)

0.036*

ER status

Negative

Ref

Positive

3.58 (1.34 - 9.54)

0.011

PR status

Negative

Ref

Positive

2.50 (1.01 - 6.17)

0.047

BMI (WHO Asia-Pacific) (mean ± SD)

Obese

Ref

Overweight

1.19 (0.34 - 4.19)

0.790

Normal

1.35 (0.47 - 3.88)

0.578

Underweight

0.92 (0.19 - 4.54)

0.922

Radiotherapy

Ref

Yes

1.06 (0.40 - 2.83)

0.911

Number of chemotherapy cycles

< 8

Ref

≥ 8

2.75 (1.09 - 6.96)

0.033

2.66 (0.85 - 8.35)

0.094

Anthracycline-taxane regimen

Ref

Yes

1.69 (0.39 - 7.30)

0.480

Hormonal therapy

Ref

Yes

5.00 (1.87 - 13.36)

0.001

4.96 (1.58 - 15.53)

0.006*