BRCA 突变携带者预防性手术的风险降低及生存获益：一项系统评价
Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review.
作者信息
Ludwig Kandice K, Neuner Joan, Butler Annabelle, Geurts Jennifer L, Kong Amanda L
机构信息
Department of Surgery, Indiana University School of Medicine, Carmel, IN, USA.
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
出版信息
Am J Surg. 2016 Oct;212(4):660-669. doi: 10.1016/j.amjsurg.2016.06.010. Epub 2016 Jul 18.
BACKGROUND
Mutations in BRCA1 or BRCA2 genes results in an elevated risk for developing both breast and ovarian cancers over the lifetime of affected carriers. General surgeons may be faced with questions about surgical risk reduction and survival benefit of prophylactic surgery.
METHODS
A systematic literature review was performed using the electronic databases PubMed, OVID MEDLINE, and Scopus comparing prophylactic surgery vs observation with respect to breast and ovarian cancer risk reduction and mortality in BRCA mutation carriers.
RESULTS
Bilateral risk-reducing mastectomy provides a 90% to 95% risk reduction in BRCA mutation carriers, although the data do not demonstrate improved mortality. The reduction in ovarian and breast cancer risks using risk-reducing bilateral salpingo-oophorectomy has translated to improvement in survival.
CONCLUSIONS
Clinical management of patients at increased risk for breast cancer requires consideration of risk, patient preference, and quality of life.
背景
BRCA1或BRCA2基因的突变会使受影响的携带者在一生中患乳腺癌和卵巢癌的风险升高。普通外科医生可能会面临有关降低手术风险以及预防性手术的生存获益等问题。
方法
利用电子数据库PubMed、OVID MEDLINE和Scopus进行了一项系统的文献综述，比较了预防性手术与观察对于BRCA突变携带者降低乳腺癌和卵巢癌风险及死亡率的效果。
结果
双侧预防性乳房切除术可使BRCA突变携带者的风险降低90%至95%，不过数据并未表明死亡率有所改善。采用双侧预防性输卵管卵巢切除术降低卵巢癌和乳腺癌风险已转化为生存改善。
结论
对乳腺癌风险增加的患者进行临床管理需要考虑风险、患者偏好和生活质量。
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