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Background <p>Anti-Müllerian hormone (AMH) is widely used to assess ovarian reserve in young women with breast cancer. However, its interpretation during gonadotropin-releasing hormone agonist (GnRHa)-based endocrine therapy remains challenging because pharmacologic ovarian suppression may alter AMH levels over time. We aimed to characterize longitudinal AMH dynamics according to chemotherapy exposure and subsequent GnRHa-based endocrine therapy.</p> Methods <p>We conducted a retrospective longitudinal cohort study of women diagnosed with early breast cancer before age 40 at Sun Yat-sen University Cancer Center between August 2019 and December 2024. Patients were categorized into four groups according to chemotherapy exposure and GnRHa-based endocrine therapy. Longitudinal trajectories of log-transformed AMH were modeled using linear mixed-effects models with restricted cubic splines, adjusting for prespecified clinical covariates. Sensitivity analyses included baseline-AMH adjustment and exclusion of observations with extreme standardized residuals.</p> Results <p>The full cohort included 685 women contributing 1758 AMH measurements. The adjusted complete-case model included 613 women contributing 1602 measurements. The group-by-time interaction was significant (likelihood ratio χ<sup>2</sup> = 249.33, df = 9, <i>P</i> &lt; 0.001), demonstrating distinct AMH trajectories across treatment groups. Among women without chemotherapy, predicted AMH did not differ significantly between those with and without GnRHa-based endocrine therapy. Among chemotherapy-treated patients, the GnRHa-based endocrine therapy group was associated with lower predicted AMH at 12 and 36&#xa0;months, but the differences attenuated at later follow-up. Similar trajectory patterns were observed in sensitivity analyses.</p> Conclusions <p>AMH trajectories during GnRHa-based endocrine therapy are time-dependent and influenced by treatment context. AMH measurements during GnRHa exposure should be interpreted in relation to treatment timing and longitudinal changes rather than as isolated indicators of ovarian reserve.</p>

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Time-dependent anti-Müllerian hormone dynamics during GnRHa-based endocrine therapy in young breast cancer survivors: a longitudinal real-world cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Chang Jiang,
  • Xiwen Bi,
  • Xin Hua,
  • Zhongyu Yuan,
  • Ying Guo,
  • Shusen Wang,
  • Yanxia Shi,
  • Fei Xu,
  • Yongyi Zhong,
  • Cong Xue

摘要

Background

Anti-Müllerian hormone (AMH) is widely used to assess ovarian reserve in young women with breast cancer. However, its interpretation during gonadotropin-releasing hormone agonist (GnRHa)-based endocrine therapy remains challenging because pharmacologic ovarian suppression may alter AMH levels over time. We aimed to characterize longitudinal AMH dynamics according to chemotherapy exposure and subsequent GnRHa-based endocrine therapy.

Methods

We conducted a retrospective longitudinal cohort study of women diagnosed with early breast cancer before age 40 at Sun Yat-sen University Cancer Center between August 2019 and December 2024. Patients were categorized into four groups according to chemotherapy exposure and GnRHa-based endocrine therapy. Longitudinal trajectories of log-transformed AMH were modeled using linear mixed-effects models with restricted cubic splines, adjusting for prespecified clinical covariates. Sensitivity analyses included baseline-AMH adjustment and exclusion of observations with extreme standardized residuals.

Results

The full cohort included 685 women contributing 1758 AMH measurements. The adjusted complete-case model included 613 women contributing 1602 measurements. The group-by-time interaction was significant (likelihood ratio χ2 = 249.33, df = 9, P < 0.001), demonstrating distinct AMH trajectories across treatment groups. Among women without chemotherapy, predicted AMH did not differ significantly between those with and without GnRHa-based endocrine therapy. Among chemotherapy-treated patients, the GnRHa-based endocrine therapy group was associated with lower predicted AMH at 12 and 36 months, but the differences attenuated at later follow-up. Similar trajectory patterns were observed in sensitivity analyses.

Conclusions

AMH trajectories during GnRHa-based endocrine therapy are time-dependent and influenced by treatment context. AMH measurements during GnRHa exposure should be interpreted in relation to treatment timing and longitudinal changes rather than as isolated indicators of ovarian reserve.