PURPOSE To determine the longitudinal impact of adjuvant chemotherapy and tamoxifen-only treatments on the reproductive potential of women with breast cancer by using a sensitive ovarian reserve marker anti-Mullerian hormone (AMH) as a surrogate. METHODS One-hundred-and-forty-two women with a primary diagnosis of breast cancer were prospectively followed with serum AMH assessments before the initiation, and 12, 18 and 24 months after the completion of adjuvant chemotherapy or the start of tamoxifen-only treatment. The chemotherapy regimens were classified into Anthracycline-Cyclophosphamide-based (AC-based) and Cyclophosphamide-Methotrexate + 5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed effects model for treatment effects over time, adjusting for baseline age and BMI. RESULTS Both chemotherapy regimens resulted in significant decline in ovarian reserve compared to the tamoxifen-only treatment (p < 0.0001 either regimen vs. tamoxifen for overall trend). AMH levels sharply declined at 12 months but did not show a significant recovery from 12 to 18 and 18 to 24 months after the completion of AC-based or CMF regimens. The degree of decline did not differ between the two chemotherapy groups (p = 0.53). In contrast, tamoxifen-only treatment did not significantly alter the age-adjusted serum AMH levels over the 24-month follow up. Likewise, the use of adjuvant tamoxifen following AC-based regimens did not affect AMH recovery. CONCLUSIONS Both AC-based regimens and CMF significantly compromise ovarian reserve, without a recovery beyond 12 months post-chemotherapy. In contrast, tamoxifen-only treatment does not seem to alter ovarian reserve. These data indicate that the commonly used chemotherapy regimens but not the hormonal therapy compromise future reproductive potential.

中文翻译：

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辅助化疗或他莫昔芬单药对年轻乳腺癌女性卵巢储备的影响。

目的 通过使用敏感的卵巢储备标志物抗苗勒管激素 (AMH) 作为替代物，确定辅助化疗和仅他莫昔芬治疗对乳腺癌女性生殖潜力的纵向影响。方法 对 142 名初步诊断为乳腺癌的女性进行前瞻性随访，在开始前以及完成辅助化疗或开始仅他莫昔芬治疗后 12、18 和 24 个月进行血清 AMH 评估. 化疗方案分为基于蒽环类-环磷酰胺（AC-based）和环磷酰胺-甲氨蝶呤+5-氟尿嘧啶（CMF）。纵向数据通过混合效应模型分析随时间的治疗效果，调整基线年龄和 BMI。结果 与仅用他莫昔芬治疗相比，两种化疗方案均导致卵巢储备功能显着下降（总体趋势，任一方案与他莫昔芬相比，p < 0.0001）。AMH 水平在 12 个月时急剧下降，但在基于 AC 或 CMF 方案完成后的 12 至 18 个月和 18 至 24 个月未显示显着恢复。两个化疗组之间的下降程度没有差异（p = 0.53）。相比之下，在 24 个月的随访中，仅使用他莫昔芬的治疗并未显着改变年龄调整后的血清 AMH 水平。同样，在基于 AC 的方案后使用辅助他莫昔芬不会影响 AMH 的恢复。结论 基于 AC 的方案和 CMF 都显着损害了卵巢储备功能，而且在化疗后 12 个月后都没有恢复。相比之下，仅他莫昔芬治疗似乎不会改变卵巢储备。这些数据表明，常用的化疗方案而不是激素治疗会损害未来的生殖潜力。