PREDICTIVE VALUE OF AGE AND SERIAL ANTI-MÜLLERIAN HORMONE LEVELS FOR OVARIAN RECOVERY FOLLOWING CHEMOTHERAPY IN HORMONE RECEPTOR–NEGATIVE BREAST CANCER: A LONGITUDINAL STUDY

Abstract

Objective: To investigate the association between menstrual status at 12 months after completion of chemotherapy and serial serum AMH levels, evaluated both as absolute concentrations and as relative changes from baseline, in a homogeneous cohort of young women with hormone receptor-negative breast cancer.

Methods: A prospective longitudinal study was conducted from January 2024 to December 2025. Women aged 18–45 years with regular menstrual cycles and histologically confirmed with newly diagnosed HR-negative breast cancer planned for chemotherapy were enrolled. Venous blood samples were collected for AMH measurement at baseline (bAMH), immediately post-chemotherapy (AMH0), and at 3 (AMH3) and 6 (AMH6) months post-treatment. AMH recovery at 3 months (rAMH3) and 6 months (rAMH6) was calculated as the percentage change from baseline. Chemotherapy-induced-amenorrhea (CIA) was defined as absence of menstruation for at least 12 consecutive months following completion of chemotherapy.

Results: Among 79 participants, women aged 40-45 years accounted for 55.7% of the cohort and 84.8% received an Antracycline-Cyclophosphamid (AC) protocol for chemotherapy.  The CIA rate was 39.2%. bAMH, AMH6, rAMH6, and age demonstrated strong predictive capability for CIA at 12 months, yielding AUCs of 0.83 (95%CI: 0.74-0.93), 0.84 (95%CI: 0.75-0.93), 0.81 (95%CI: 0.71-0.91), and 0.82 (95%CI: 0.72-0.91), respectively. Multivariable analysis confirmed that age >42.5 years (OR = 0.823; 95% CI: 0.699–0.969) and bAMH <0.937 ng/mL (OR = 1.133; 95% CI: 1.027–1.250) are independent predictors of CIA.

Conclusion: Although 6-month AMH monitoring offers valuable confirmation, this study indicates that chronological age and pre-treatment AMH may serve as useful baseline predictors for CIA. This risk stratification could help identify patients at highest risk of CIA, thereby supporting individualized counseling on ovarian protection strategies, including the consideration of GnRH agonists prior to chemotherapy.