Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Mt. Sinai Health System, Toronto, ON, Canada.
Gynecol Oncol. 2019 Jan;152(1):145-150. doi: 10.1016/j.ygyno.2018.10.040. Epub 2018 Nov 7.
Prophylactic bilateral salpingo-oophorectomy (BSO) is recommended at an early age to BRCA mutation carriers to prevent ovarian cancer. It is critical to evaluate the impact of BSO on non-cancer outcomes, including quality of life (QOL), menopausal symptoms and sexual functioning.
BRCA mutation carriers who elected to undergo a BSO completed three questionnaires prior to surgery and then again approximately one and three years following surgery which included: 1) medical history questionnaire, 2) Menopause-Specific Quality of Life Intervention questionnaire and 3) Sexual Activity Questionnaire. The change in quality of life, menopausal symptoms and sexual functioning before and after oophorectomy was determined using a paired t-test and stratified by menopausal status at surgery.
We included 140 BRCA mutation carriers with an average follow-up of 3.5 years following BSO. Among 93 women who were premenopausal, oophorectomy was associated with an increase in menopausal symptoms (vasomotor, physical) (P < 0.001) and a decline in sexual functioning (discomfort, pleasure) (P ≤ 0.0001), but had no impact on overall QOL (P = 0.31). HRT mitigated, but did not eliminate the adverse effects. Women who were postmenopausal at surgery (n = 47) experienced an increase in physical symptoms (P = 0.03) and a decline in sexual functioning (discomfort) (P = 0.004) and in overall QOL (P = 0.04).
This study demonstrates that 3.5 years after oophorectomy, BRCA mutation carriers experience a significant worsening of menopausal symptoms and a decline in sexual functioning, particularly among those who underwent surgery prior to natural menopause. The use of HRT mitigated some but not all the effects. Overall, women who were premenopausal at surgery did not experience a decline in their QOL.
预防性双侧输卵管卵巢切除术（BSO）建议在早期对 BRCA 基因突变携带者进行，以预防卵巢癌。评估 BSO 对非癌症结局的影响至关重要，包括生活质量（QOL）、更年期症状和性功能。
选择进行 BSO 的 BRCA 基因突变携带者在手术前完成了三个问卷，然后在手术后大约一年和三年再次完成了三个问卷，包括：1）病史问卷，2）更年期特异性生活质量干预问卷，3）性活动问卷。使用配对 t 检验和手术时的绝经状态分层，确定卵巢切除术前和术后生活质量、更年期症状和性功能的变化。
我们纳入了 140 名 BRCA 基因突变携带者，平均随访 3.5 年。在 93 名绝经前女性中，卵巢切除术后更年期症状（血管舒缩、躯体）增加（P<0.001），性功能下降（不适、愉悦）（P≤0.0001），但对整体 QOL 无影响（P=0.31）。HRT 减轻了但不能消除不良影响。手术时绝经后的 47 名女性经历了躯体症状增加（P=0.03）和性功能下降（不适）（P=0.004）以及整体 QOL 下降（P=0.04）。
本研究表明，卵巢切除术后 3.5 年，BRCA 基因突变携带者经历更年期症状明显恶化和性功能下降，尤其是在自然绝经前接受手术的女性。HRT 减轻了一些但不是所有的影响。总体而言，手术时处于绝经前的女性生活质量没有下降。
