Department of Gynecological-Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Department of Woman and Child Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italia.
Ann Surg Oncol. 2018 Nov;25(12):3701-3708. doi: 10.1245/s10434-018-6700-6. Epub 2018 Aug 20.
The aim of this study was to assess the correlation between BRCA mutation status and disease presentation, treatment strategy, and survival in a multicenter series of recurrent high-grade serous ovarian cancer (HGSOC) women.
A consecutive series of recurrent HGSOC patients with partially or fully platinum-sensitive disease admitted to the Gynecologic Oncology Units of the Catholic University of the Sacred Heart and Sapienza University of Rome. Main eligibility criteria were known BRCA 1/2 germline mutation status and a minimum follow-up period from recurrence of at least 6 months.
Overall, 126 patients met the eligibility criteria, of whom 76 (60%) were BRCA wild-type (BRCAwt) and 50 (40%) were BRCA 1/2 germline mutation carriers (BRCAmut). Among the latter, 37 (74%) patients presented with BRCA1 mutation, and 13 (26%) presented with BRCA2. No differences were found regarding patterns of disease presentation between BRCAwt and BRCAmut women. BRCAmut patients had the best post-recurrence survival (PRS) regardless of having received secondary cytoreductive surgery (SCS) or not, with a 5-year PRS of 73% in non-resected women versus 78% in resected women (p = 0.558). Conversely, BRCAwt patients who underwent complete SCS had a significantly longer PRS compared with BRCAwt patients who did not receive surgery (5-year PRS of 54% vs. 42%; p = 0.048).
Recurrent ovarian cancer BRCAmut patients have the best prognosis regardless of SCS, whereas PRS in BRCAwt women can improve when complete SCS is performed. The identification and incorporation of predictive biomarkers such as BRCA status to tailor the medical and surgical approach is paramount to the success of recurrent HGSOC treatments.
本研究旨在评估 BRCA 突变状态与复发性高级别浆液性卵巢癌（HGSOC）女性的疾病表现、治疗策略和生存之间的相关性。
连续入组了在天主教圣心大学和罗马萨皮恩扎大学妇科肿瘤病房接受治疗的部分或完全铂敏感复发性 HGSOC 患者。主要入选标准为已知 BRCA1/2 种系突变状态和至少 6 个月的复发后随访时间。
共有 126 名患者符合入选标准，其中 76 名（60%）为 BRCA 野生型（BRCAwt），50 名（40%）为 BRCA1/2 种系突变携带者（BRCAmut）。后者中有 37 名（74%）患者存在 BRCA1 突变，13 名（26%）患者存在 BRCA2 突变。BRCAwt 和 BRCAmut 女性的疾病表现模式无差异。无论是否接受二次细胞减灭术（SCS），BRCAmut 患者的复发后生存（PRS）最佳，未接受手术的非切除女性的 5 年 PRS 为 73%，而接受手术的女性为 78%（p=0.558）。相反，接受完全 SCS 的 BRCAwt 患者的 PRS 明显长于未接受手术的 BRCAwt 患者（5 年 PRS 分别为 54%和 42%；p=0.048）。
复发性卵巢癌 BRCAmut 患者无论是否接受 SCS，预后最佳，而 BRCAwt 女性的 PRS 可通过完全 SCS 提高。识别和纳入预测生物标志物（如 BRCA 状态）以定制医疗和手术方法对于复发性 HGSOC 治疗的成功至关重要。
