Abstract:

Objective

To evaluate the roles of estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) in discriminating menopausal status of invasive breast cancer patients using receiver operating characteristics (ROC) curve.

Methods

Analysis was undertaken among 128 premenopausal and 204 postmenopausal invasive breast cancer patients. The efficient and useful cut-off points of the three sex hormones were achieved based on ROC curve.

Results

The areas under the ROC curve of E2, FSH and LH were 0.939 5 (95%CI:0.911 0-0.967 9),0.9714 (95%CI: 0.951 4-0.991 4) and 0.905 3 (95%CI:0.868 1-0.942 4) respectively, and the cut-off point was 49.52 pg/ml, 21.96 mU/ml and 13.25 mU/ml respectively, with a maximum of the Youden index. The area under the ROC curve of FSH was significantly better than E2 (P=0.036) and LH (P<0.001). E2 and FSH were selected into the logistic regression model,the area under the ROC curve was 0.977 4 (95%CI:0.959 7-0.995 2). The probability of menopause (Pm) was 0.46 with a maximum of the Youden index.

Conclusions

E2, FSH and LH can effectively discriminate menopausal status of invasive breast cancer patients. The discrimination capabicity of FSH is significantly better than that of E2 or LH. The discrimination capability of combining E2 and FSH is better than using any of the three hormones independently. LH is not recommended to identify menopausal status, because it fails to be selected into the logistic regression model, and the area under the ROC curve is the least among the three hormones. The cut-off point may be adjusted according to the demand of clinical practice.

Key words: breast neoplasms, menopause, ROC curve, gonadal steroid hormones