Abramson Cancer Center, The University of Pennsylvania School of Medicine, 3W Perelman Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Breast Cancer Res Treat. 2010 Nov;124(1):195-203. doi: 10.1007/s10549-010-0799-x. Epub 2010 Feb 24.
Risk-reducing salpingo-oophorectomy (RRSO) is widely used for cancer risk reduction in BRCA1 or BRCA2 (BRCA1/2) mutation carriers. Occult ovarian/fallopian tube cancers (OOC) detected at the time of RRSO have been reported in several studies with wide variability in reported prevalence. We estimated the prevalence of OOC in a prospective cohort of 647 BRCA1/2 mutation carriers from 18 centers (PROSE consortium) who underwent RRSO between 2001 and 2008. OOC was detected in 16 of 647 women (2.5%). The mean age at RRSO was 51.7 in those with OOC versus 46.6 in those without OOC (P = 0.017). Twelve of the 16 OOCs (75%) were diagnosed in women with BRCA1 mutations. Thirty-eight percent of women with OOC had stage 1 cancer versus none of the women in the PROSE database diagnosed with ovarian cancer outside of screening. Among 385 women (60%) in whom pathology reports were available for central review, 246 (64%) RRSOs were performed at participating PROSE centers while 139 (36%) were performed at local sites. Ovarian and fallopian tube tissues removed at major genetics referral centers were significantly more likely to have been examined in toto compared to specimens obtained at non-referral centers (75% vs. 30%, P < 0.001). Our results confirm that OOC may be found at the time of RRSO in BRCA1/2 mutation carriers and suggest that OOC are of a more favorable stage than cancers found outside RRSO. An unacceptably high proportion of pathologic examinations did not adequately examine ovaries and fallopian tubes obtained at RRSO.
风险降低的输卵管卵巢切除术（RRSO）广泛用于降低 BRCA1 或 BRCA2（BRCA1/2）突变携带者的癌症风险。在几项研究中，RRSO 时发现了隐匿性卵巢/输卵管癌（OOC），其报道的患病率差异很大。我们估计了 18 个中心的 647 名 BRCA1/2 突变携带者的前瞻性队列中 OOC 的患病率（PROSE 联盟），他们在 2001 年至 2008 年期间接受了 RRSO。在 647 名女性中，有 16 名（2.5%）发现 OOC。OOC 组 RRSO 时的平均年龄为 51.7 岁，无 OOC 组为 46.6 岁（P=0.017）。16 例 OOC 中，有 12 例（75%）诊断为 BRCA1 突变女性。38%的 OOC 妇女患有 I 期癌症，而 PROSE 数据库中没有在筛查以外诊断为卵巢癌的妇女。在 385 名（60%）可获得中心病理报告的女性中，246 名（64%）RRSO 在参与 PROSE 的中心进行，而 139 名（36%）在当地进行。与非转诊中心相比，主要遗传学转诊中心切除的卵巢和输卵管组织更有可能进行全面检查（75%比 30%，P<0.001）。我们的结果证实，BRCA1/2 突变携带者在 RRSO 时可能发现 OOC，并且表明 OOC 比 RRSO 外发现的癌症分期更有利。接受 RRSO 的卵巢和输卵管组织的病理检查未能充分检查的比例高得令人无法接受。
