Background: Breast cancer (BC) in reproductive-age women raises concerns about fertility preservation, particularly as systemic therapies may compromise ovarian function. Evidence on whether tumor immunohistotype influences ovarian reserve and fertility preservation outcomes remains limited. Methods: We conducted a prospective cohort study of BC patients referred for fertility preservation counseling between November 2020 and May 2025. Ovarian reserve was assessed using anti-Müllerian hormone (AMH) levels and antral follicle count (AFC). Controlled ovarian stimulation (COS) and oocyte cryopreservation were performed according to standardized protocols. Patients were stratified into triple-negative BC (TNBC) and hormone receptor-positive (HR+) and/or HER2+ groups. The primary endpoint was ovarian reserve differences by subtype; the secondary endpoints were ovarian response and oocyte yield. Results: Of 358 patients, 152 were enrolled, and 139 (91.4%) underwent COS, for a total of 145 cycles. The median age was 33 years, median AMH 5.4 ng/mL, and median AFC 17. No significant differences were observed between the TNBC and HR+/HER2+ groups in AMH, AFC, oocyte yield, or mature oocyte rate. Sub-analysis revealed a significantly lower mature oocyte yield in luminal-B tumors. Conclusions: Ovarian reserve and cryopreservation outcomes appeared preserved in TNBC compared with those in patients with HR+/HER2+ BC at diagnosis. These findings provide reassurance that baseline fertility potential is not compromised by tumor immunohistotype.
背景：育龄期女性乳腺癌患者常面临生育力保存问题，尤其全身性治疗可能损害卵巢功能。目前关于肿瘤免疫组化分型是否影响卵巢储备功能及生育力保存结局的证据仍有限。 方法：本研究对2020年11月至2025年5月期间接受生育力保存咨询的乳腺癌患者开展前瞻性队列研究。通过抗缪勒管激素水平和窦卵泡计数评估卵巢储备功能，并按照标准化方案实施控制性卵巢刺激与卵母细胞冷冻保存。将患者分为三阴性乳腺癌组和激素受体阳性及/或HER2阳性组。主要终点为不同亚型间的卵巢储备功能差异，次要终点包括卵巢反应性和获卵数。 结果：在358例患者中，152例入组研究，其中139例（91.4%）接受控制性卵巢刺激，共完成145个周期。患者中位年龄33岁，中位抗缪勒管激素水平5.4 ng/mL，中位窦卵泡计数17个。三阴性乳腺癌组与激素受体阳性/HER2阳性组在抗缪勒管激素水平、窦卵泡计数、获卵数及成熟卵母细胞率方面均无显著差异。亚组分析显示Luminal-B型肿瘤患者的成熟卵母细胞获卵数显著降低。 结论：与激素受体阳性/HER2阳性乳腺癌患者相比，三阴性乳腺癌患者在确诊时的卵巢储备功能及冷冻保存结局未见明显受损。这些发现证实肿瘤免疫组化分型不会损害基线生育潜力。
肿瘤(癌症)患者之家