Ricciardi Enzo, Tomao Federica, Aletti Giovanni, Bazzurini Luca, Bocciolone Luca, Boveri Sara, Landoni Fabio, Lapresa Maria Teresa, Maruccio Matteo, Parma Gabriella, Peccatori Fedro, Petrella Maria Cristina, Zanagnolo Vanna, Colombo Nicoletta, Maggioni Angelo
Division of Gynecology, European Institute of Oncology, Milan, Italy
Division of Gynecology, European Institute of Oncology, Milan, Italy.
Anticancer Res. 2017 Sep;37(9):5241-5248. doi: 10.21873/anticanres.11948.
BACKGROUND/AIM: Occult cancers' reported rates vary from 2-12% and serous tubal intraepithelial carcinomas (STICs) have been identified in 3-12% of the prophylactically removed tubes of women carrying a BRCA mutation. The aim of this study was to evaluate the incidence of tubal minor epithelial atypia (STIL), STIC, and occult invasive cancer and to evaluate the cancer-specific mortality in a prospective series of women at higher risk of ovarian and breast cancer undergoing risk-reducing salpingo-oophorectomy (RRSO) n a tertiary cancer center.
A series of RRSO specimens (including endometrial biopsy) from women carrying a BRCA mutation, BRCA-unknown and BRCA-negative were collected between January 1998 and April 2016 at the Division of Gynecology at the European Institute of Oncology. Inclusion criteria were: asymptomatic women who had a negative gynecologic screening within 3 months prior to RRSO. Exclusion criteria were: women with ovarian/tubal cancer prior to RRSO.
A total of 411 women underwent RRSO. Median age at RRSO was 47.0 years (range=32-70 years); 75.2% had a history of breast cancer. Fifteen women were diagnosed with an occult cancer (7 STIC, 4 invasive cancers, 2 breast cancers metastatic to the adnexa, 2 endometrial cancer) (3.6%). Sixteen showed a STIL (3.9%). When excluding cases with preoperative positive markers, the occult invasive cancer rate drops to 1.5%.
Our study, covering an 18-year period, shows a substantial low risk of occult cancer among a high-risk population of women undergoing RRSO. Our data still support the indication for RRSO in higher-risk patients. An endometrial biopsy should also be routinely obtained as it raises the chances of detecting occult endometrial cancers that may be otherwise missed.
背景/目的：隐匿性癌症的报告发生率在2%至12%之间，在携带BRCA突变的女性预防性切除的输卵管中，浆液性输卵管上皮内癌（STIC）的检出率为3%至12%。本研究的目的是评估输卵管轻度上皮异型增生（STIL）、STIC和隐匿性浸润癌的发生率，并评估在一家三级癌症中心接受降低风险的输卵管卵巢切除术（RRSO）的卵巢癌和乳腺癌高危女性前瞻性系列研究中的癌症特异性死亡率。
1998年1月至2016年4月期间，在欧洲肿瘤研究所妇科收集了一系列携带BRCA突变、BRCA情况不明和BRCA阴性的女性的RRSO标本（包括子宫内膜活检）。纳入标准为：RRSO前3个月内妇科筛查阴性的无症状女性。排除标准为：RRSO前患有卵巢/输卵管癌的女性。
共有411名女性接受了RRSO。RRSO时的中位年龄为47.0岁（范围=32 - 70岁）；75.2%有乳腺癌病史。15名女性被诊断为隐匿性癌症（7例STIC、4例浸润癌、2例转移至附件的乳腺癌、2例子宫内膜癌）（3.6%）。16例显示STIL（3.9%）。排除术前标志物阳性的病例后，隐匿性浸润癌的发生率降至1.5%。
我们这项涵盖18年的研究表明，在接受RRSO的高危女性人群中，隐匿性癌症的风险相当低。我们的数据仍然支持对高危患者进行RRSO的指征。还应常规进行子宫内膜活检，因为这增加了检测可能漏诊的隐匿性子宫内膜癌的机会。
