Laki Fatima, Kirova Youlia M, This Pascale, Plancher Corinne, Asselain Bernard, Sastre Xavier, Stoppa-Lyonnet Dominique, Salmon Remy
Department of Surgery, Institut Curie, Paris, France.
Cancer. 2007 May 1;109(9):1784-90. doi: 10.1002/cncr.22603.
Prophylactic salpingo-oophorectomy (SO), which is recommended in BRCA1/2 mutation carriers, still needs to be reappraised.
In all, 89 BRCA1/BRCA2 mutation carriers underwent SO between 1994-2004. Past medical and familial history, SO, results and survival after SO were analyzed.
The series consisted of 56 BRCA1 and 33 BRCA2 mutation carriers. All but 1 had a family history of breast (BC) and/or ovarian cancer; 42 BRCA1 and 31 BRCA2 had a personal history of BC. The median age at SO was 44 (BRCA1) and 49.5 (BRCA2) years for women without previous BC (not significant) and 48 (BRCA1) and 53 BRCA2) years (P=.03) for women with previous BC. Occult ovarian (n=2) and/or fallopian (n=3) carcinomas were found in 4 patients (4.5%): 1 experienced recurrence (4 years), 2 are disease-free (26 and 38 months of follow-up), and 1 died from BC (12 months). Among the other 69 patients with previous BC (median follow-up, 42 months), 14 developed ipsilateral or contralateral BC and 8 developed metastatic disease. Among the 16 patients without previous BC (median follow-up, 27 months), 3 developed BC. Of the 89 patients, 85 are still alive: 3 died from BC and 1 died from pancreatic cancer. No peritoneal malignancy was observed.
This study shows that prophylactic SO remains an important option for BRCA1/2 mutation carriers as asymptomatic ovarian/fallopian cancers were found in 4.5% of patients. However, a longer follow-up and larger series are required to more precisely evaluate the benefits of this procedure in terms of BC incidence, peritoneal malignancy, or recurrence.
对于携带BRCA1/2基因突变的患者，推荐进行预防性输卵管卵巢切除术（SO），但仍需重新评估。
1994年至2004年间，共有89例携带BRCA1/BRCA2基因突变的患者接受了SO手术。分析其既往病史、家族史、SO手术情况、术后结果及生存情况。
该队列包括56例携带BRCA1基因突变和33例携带BRCA2基因突变的患者。除1例患者外，其余均有乳腺癌（BC）和/或卵巢癌家族史；42例携带BRCA1基因突变和31例携带BRCA2基因突变的患者有BC个人史。对于既往无BC的女性，SO时的中位年龄为44岁（BRCA1基因突变组）和49.5岁（BRCA2基因突变组）（无显著差异）；对于既往有BC的女性，SO时的中位年龄为48岁（BRCA1基因突变组）和53岁（BRCA2基因突变组）（P = 0.03）。4例患者（4.5%）发现隐匿性卵巢癌（n = 2）和/或输卵管癌（n = 3）：1例复发（4年），2例无疾病（随访26个月和38个月），1例死于BC（12个月）。在其他69例既往有BC的患者中（中位随访42个月），14例发生同侧或对侧BC，8例发生转移性疾病。在16例既往无BC的患者中（中位随访27个月），3例发生BC。89例患者中，85例仍存活：3例死于BC，1例死于胰腺癌。未观察到腹膜恶性肿瘤。
本研究表明，预防性SO仍然是携带BRCA1/2基因突变患者的重要选择，因为4.5%的患者发现了无症状性卵巢/输卵管癌。然而，需要更长时间的随访和更大规模的队列来更精确地评估该手术在BC发病率、腹膜恶性肿瘤或复发方面的益处。
