Amy P.M. Finch, Barry Rosen, Andrea Eisen, Kelly A. Metcalfe, Islay Thompson, Joan Murphy, Ping Sun, and Steven A. Narod, University of Toronto; Barry Rosen and Joan Murphy, Princess Margaret Hospital; Amy P.M. Finch, Islay Thompson, Ping Sun, and Steven A. Narod, Women's College Research Institute; Andrea Eisen, Sunnybrook Odette Cancer Center, Toronto; Peter Ainsworth, London Regional Cancer Program, London, Ontario; Parviz Ghadirian, University of Montreal Hospital Centre; William D. Foulkes, McGill University, Montreal, Quebec; Charmaine Kim-Sing, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Jan Lubinski, Cezary Cybulski, and Tomasz Huzarski, Pomeranian Medical University, Szczecin, Poland; Pål Møller and Lovise Maehle, Norwegian Radium Hospital and Oslo University Hospital, Oslo, Norway; Christian F. Singer, Medical University of Vienna, Vienna, Austria; Beth Karlan, Cedars-Sinai Medical Center, Beverly Hills; Susan Neuhausen, City of Hope National Medical Center, Duarte, CA; Leigha Senter, Ohio State University Medical Center, Columbus, OH; Nadine Tung, Beth Israel Deaconess Medical Center, Boston, MA; and Henry T. Lynch, Creighton University School of Medicine, Omaha, NE.
J Clin Oncol. 2014 May 20;32(15):1547-53. doi: 10.1200/JCO.2013.53.2820. Epub 2014 Feb 24.
The purposes of this study were to estimate the reduction in risk of ovarian, fallopian tube, or peritoneal cancer in women with a BRCA1 or BRCA2 mutation after oophorectomy, by age of oophorectomy; to estimate the impact of prophylactic oophorectomy on all-cause mortality; and to estimate 5-year survival associated with clinically detected ovarian, occult, and peritoneal cancers diagnosed in the cohort.
Women with a BRCA1 or BRCA2 mutation were identified from an international registry; 5,783 women completed a baseline questionnaire and ≥ one follow-up questionnaires. Women were observed until either diagnosis of ovarian, fallopian tube, or peritoneal cancer, death, or date of most recent follow-up. Hazard ratios (HRs) for cancer incidence and all-cause mortality associated with oophorectomy were evaluated using time-dependent survival analyses.
After an average follow-up period of 5.6 years, 186 women developed either ovarian (n = 132), fallopian (n = 22), or peritoneal (n = 32) cancer, of whom 68 have died. HR for ovarian, fallopian, or peritoneal cancer associated with bilateral oophorectomy was 0.20 (95% CI, 0.13 to 0.30; P < .001). Among women who had no history of cancer at baseline, HR for all-cause mortality to age 70 years associated with an oophorectomy was 0.23 (95% CI, 0.13 to 0.39; P < .001).
Preventive oophorectomy was associated with an 80% reduction in the risk of ovarian, fallopian tube, or peritoneal cancer in BRCA1 or BRCA2 carriers and a 77% reduction in all-cause mortality.
本研究旨在通过对接受预防性卵巢切除术的 BRCA1 或 BRCA2 突变携带者的年龄进行分层，估算其卵巢癌、输卵管癌或腹膜癌风险的降低程度；评估预防性卵巢切除术对全因死亡率的影响；并估算该队列中诊断出的临床发现的卵巢癌、隐匿性卵巢癌和腹膜癌的 5 年生存率。
本研究从一个国际注册中心中识别出 BRCA1 或 BRCA2 突变的女性；共有 5783 名女性完成了基线问卷和至少一次随访问卷。对这些女性进行随访，直至其被诊断出卵巢癌、输卵管癌或腹膜癌、死亡或最近一次随访日期。使用时间依赖性生存分析评估与卵巢切除术相关的癌症发病率和全因死亡率的风险比（HR）。
在平均 5.6 年的随访期后，186 名女性被诊断为卵巢癌（n = 132）、输卵管癌（n = 22）或腹膜癌（n = 32），其中 68 人死亡。双侧卵巢切除术与卵巢癌、输卵管癌或腹膜癌相关的 HR 为 0.20（95% CI，0.13 至 0.30；P <.001）。在基线时无癌症病史的女性中，与卵巢切除术相关的 70 岁前全因死亡率的 HR 为 0.23（95% CI，0.13 至 0.39；P <.001）。
预防性卵巢切除术与 BRCA1 或 BRCA2 携带者的卵巢癌、输卵管癌或腹膜癌风险降低 80%相关，与全因死亡率降低 77%相关。
