Tschernichovsky Roi, Goodman Annekathryn
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Gynecologic Oncology
Oncologist. 2017 Apr;22(4):450-459. doi: 10.1634/theoncologist.2016-0444. Epub 2017 Mar 17.
The objective of this study was to review the role of bilateral salpingo-oophorectomy in mutation (m) carriers and alternative interventions in risk reduction of ovarian cancer (OC).
A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in m carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention.
Risk-reducing bilateral salpingo-oophorectomy is an effective intervention, but its associated morbidity is substantial and seems to curtail uptake rates among the target population. Although there is much interest and a strong theoretical basis for salpingectomy with delayed oophorectomy, data on its clinical application are scarce with regard to screening, the use of an algorithmic protocol has recently shown favorable albeit indefinite results in average-risk postmenopausal women. Its incorporation into studies focused on high-risk women might help solidify a future role for screening as a bridge to surgery. The use of oral contraceptives for chemoprevention is well supported by epidemiologic studies. However, there is a lack of evidence for advocating any of the other agents proposed for this purpose, including nonsteroidal anti-inflammatory drugs, vitamin D, and retinoids.
Further studies are needed before salpingectomy with delayed oophorectomy or intensive surveillance can be offered as acceptable, less morbid alternatives to upfront oophorectomy for m carriers. 2017;22:450-459 IMPLICATIONS FOR PRACTICE: Risk-reducing bilateral salpingo-oophorectomy is currently the most effective method for reducing the risk of ovarian cancer in mutation (m) carriers. Unfortunately, it is associated with significant short- and long-term morbidity, stemming from reduced circulating estrogen. In recent years, much research has been devoted to evaluating less morbid alternatives, especially multimodal cancer screening and prophylactic salpingectomy with delayed oophorectomy. This review describes the present state of the art, with the aim of informing the counseling provided to m carriers on this complicated issue and encouraging additional research to facilitate the incorporation of such alternatives into routine practice.
本研究的目的是回顾双侧输卵管卵巢切除术在突变（m）携带者中的作用以及降低卵巢癌（OC）风险的替代干预措施。
利用PubMed、MEDLINE、EMBASE和Cochrane图书馆进行系统综述，以确定预防m携带者发生OC的不同策略的研究，包括双侧输卵管卵巢切除术、预防性输卵管切除术加延迟卵巢切除术、强化监测和化学预防。
降低风险的双侧输卵管卵巢切除术是一种有效的干预措施，但其相关的发病率较高，似乎会降低目标人群的接受率。尽管预防性输卵管切除术加延迟卵巢切除术引起了广泛关注且有坚实的理论基础，但关于其临床应用的筛查数据很少，最近一项关于算法方案的研究在平均风险的绝经后女性中显示出了良好但不确定的结果。将其纳入针对高危女性的研究可能有助于巩固筛查作为手术桥梁的未来作用。流行病学研究充分支持使用口服避孕药进行化学预防。然而，缺乏证据支持为此目的提议的任何其他药物，包括非甾体抗炎药、维生素D和类视黄醇。
在将预防性输卵管切除术加延迟卵巢切除术或强化监测作为m携带者直接卵巢切除术的可接受、发病率较低的替代方案之前，还需要进一步研究。2017年；22:450 - 459实践意义：降低风险的双侧输卵管卵巢切除术目前是降低突变（m）携带者卵巢癌风险的最有效方法。不幸的是，它与显著的短期和长期发病率相关，源于循环雌激素减少。近年来，许多研究致力于评估发病率较低的替代方案，特别是多模式癌症筛查和预防性输卵管切除术加延迟卵巢切除术。本综述描述了当前的技术水平，旨在为就这个复杂问题向m携带者提供的咨询提供信息，并鼓励进行更多研究，以促进将此类替代方案纳入常规实践。
