降低风险的输卵管卵巢切除术的病理结果：妇科肿瘤学组试验GOG-0199的初步结果
Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199.
作者信息
Sherman Mark E, Piedmonte Marion, Mai Phuong L, Ioffe Olga B, Ronnett Brigitte M, Van Le Linda, Ivanov Iouri, Bell Maria C, Blank Stephanie V, DiSilvestro Paul, Hamilton Chad A, Tewari Krishnansu S, Wakeley Katie, Kauff Noah D, Yamada S Diane, Rodriguez Gustavo, Skates Steven J, Alberts David S, Walker Joan L, Minasian Lori, Lu Karen, Greene Mark H
机构信息
Mark E. Sherman, Phuong L. Mai, Lori Minasian, and Mark H. Greene, National Cancer Institute, Rockville; Olga B. Ioffe, University of Maryland Medical Center; Brigitte M. Ronnett, Johns Hopkins Medical Institutions, Baltimore; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; Marion Piedmonte, Roswell Park Cancer Institute, Buffalo; Stephanie V. Blank, New York University School of Medicine; Noah D. Kauff, Memorial Sloan Kettering Cancer Center; New York, NY; Linda Van Le, University of North Carolina at Chapel Hill, Chapel Hill, NC; Iouri Ivanov, Columbus Cancer Council, Columbus, OH; Maria C. Bell, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Paul DiSilvestro, Women and Infants Hospital, Providence, RI; Krishnansu S. Tewari, University of California Medical Center Irvine, Orange, CA; Katie Wakeley, Tufts University; Steven J. Skates, Massachusetts General Hospital, Boston, MA; S. Diane Yamada, University of Chicago, Chicago; Gustavo Rodriguez, North Shore University Health System, Evanston, IL; David S. Alberts, University of Arizona Cancer Center, Tucson, AZ; Joan L. Walker, University of Oklahoma, Oklahoma City, OK; and Karen Lu, MD Anderson Cancer Center, Houston, TX.
出版信息
J Clin Oncol. 2014 Oct 10;32(29):3275-83. doi: 10.1200/JCO.2013.54.1987. Epub 2014 Sep 8.
PURPOSE
Risk-reducing salpingo-oophorectomy (RRSO) lowers mortality from ovarian/tubal and breast cancers among BRCA1/2 mutation carriers. Uncertainties persist regarding potential benefits of RRSO among high-risk noncarriers, optimal surgical age, and anatomic origin of clinically occult cancers detected at surgery. To address these topics, we analyzed surgical treatment arm results from Gynecologic Oncology Group Protocol-0199 (GOG-0199), the National Ovarian Cancer Prevention and Early Detection Study.
PARTICIPANTS AND METHODS
This analysis included asymptomatic high-risk women age ≥ 30 years who elected RRSO at enrollment. Women provided risk factor data and underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound (TVU). RRSO specimens were processed according to a standardized tissue processing protocol and underwent central pathology panel review. Research-based BRCA1/2 mutation testing was performed when a participant's mutation status was unknown at enrollment. Relationships between participant characteristics and diagnostic findings were assessed using univariable statistics and multivariable logistic regression.
RESULTS
Invasive or intraepithelial ovarian/tubal/peritoneal neoplasms were detected in 25 (2.6%) of 966 RRSOs (BRCA1 mutation carriers, 4.6%; BRCA2 carriers, 3.5%; and noncarriers, 0.5%; P < .001). In multivariable models, positive BRCA1/2 mutation status (P = .0056), postmenopausal status (P = .0023), and abnormal CA-125 levels and/or TVU examinations (P < .001) were associated with detection of clinically occult neoplasms at RRSO. For 387 women with negative BRCA1/2 mutation testing and normal CA-125 levels, findings at RRSO were benign.
CONCLUSION
Clinically occult cancer was detected among 2.6% of high-risk women undergoing RRSO. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or TVU were associated with cancer detection at RRSO. These data can inform management decisions among women at high risk of ovarian/tubal cancer.
目的
降低风险的输卵管卵巢切除术（RRSO）可降低BRCA1/2突变携带者患卵巢癌/输卵管癌和乳腺癌的死亡率。对于高危非携带者进行RRSO的潜在益处、最佳手术年龄以及手术中发现的临床隐匿性癌症的解剖学起源仍存在不确定性。为了解决这些问题，我们分析了妇科肿瘤学组协议-0199（GOG-0199）即国家卵巢癌预防与早期检测研究中手术治疗组的结果。
参与者与方法
该分析纳入了年龄≥30岁、无症状且在入组时选择RRSO的高危女性。女性提供了风险因素数据，并接受了术前癌抗原125（CA-125）血清检测和经阴道超声（TVU）检查。RRSO标本按照标准化组织处理方案进行处理，并接受中央病理小组审查。当参与者的突变状态在入组时未知时，进行基于研究的BRCA1/2突变检测。使用单变量统计和多变量逻辑回归评估参与者特征与诊断结果之间的关系。
结果
在966例RRSO中，有25例（2.6%）检测到浸润性或上皮内卵巢癌/输卵管癌/腹膜癌（BRCA1突变携带者为4.6%；BRCA2携带者为3.5%；非携带者为0.5%；P <.001）。在多变量模型中，BRCA1/2突变状态阳性（P =.0056）、绝经后状态（P =.0023）以及CA-125水平异常和/或TVU检查异常（P <.001）与RRSO时临床隐匿性肿瘤的检测相关。对于387例BRCA1/2突变检测阴性且CA-125水平正常的女性，RRSO时的结果为良性。
结论
在接受RRSO的高危女性中，2.6%检测到临床隐匿性癌症。BRCA1/2突变、绝经后状态以及术前CA-125和/或TVU异常与RRSO时癌症的检测相关。这些数据可为卵巢癌/输卵管癌高危女性的管理决策提供参考。
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