Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Weill Cornell Medical College of Cornell University, New York, NY 10065, USA.
Gynecol Oncol. 2019 Jul;154(1):144-149. doi: 10.1016/j.ygyno.2019.05.004. Epub 2019 May 18.
To evaluate clinical outcomes of patients with BRCA-associated ovarian cancer who developed brain metastases (BM).
Patients with epithelial ovarian, fallopian tube, and primary peritoneal cancer (EOC) and BM, treated at a single institution from 1/1/2008-7/1/2018, were identified from two institutional databases. Charts and medical records were retrospectively reviewed for clinical characteristics and germline BRCA mutation status. Appropriate statistics were used.
Of 3649 patients with EOC, 91 had BM (2.5%). Germline mutation status was available for 63 (69%) cases; 21 (35%) of these harbored a BRCA1/2 mutation (15 BRCA1, 6 BRCA2). Clinical characteristics were similar between groups. BM were diagnosed at a median of 31 months (95% CI, 22.6-39.4) in BRCA-mutated (mBRCA) and 32 months (95% CI, 23.7-40.3) in wild-type BRCA (wtBRCA) (p = 0.78) patients. Brain metastases were the only evidence of disease at time of BM diagnoses in 48% (n = 10) mBRCA and 19% (n = 8) wtBRCA (p = 0.02) patients. There was no difference in treatment of BM by mutation status (p = 0.84). Survival from time of BM diagnosis was 29 months (95%CI, 15.5-42.5) in mBRCA and 9 months (95% CI, 5.5-12.5) in wtBRCA patients, with an adjusted hazard ratio (HR) of 0.53, p = 0.09; 95% CI, 0.25-1.11. HR was adjusted for presence of systemic disease at time of BM diagnosis.
This is the largest study to date comparing outcomes in patients with EOC and BM by mutation status. mBRCA patients were more likely to have isolated BM, which may be a factor in their long survival. This supports the pursuit of aggressive treatment for mBRCA EOC patients with BM. Additional studies examining the correlation of BRCA mutational status with BM are warranted.
评估发生脑转移（BM）的 BRCA 相关卵巢癌患者的临床结局。
从两个机构数据库中确定了 2008 年 1 月 1 日至 2018 年 7 月 1 日在一家机构接受治疗的上皮性卵巢癌、输卵管癌和原发性腹膜癌（EOC）和 BM 患者。回顾性分析图表和病历，以了解临床特征和种系 BRCA 突变状态。使用了适当的统计学方法。
在 3649 名 EOC 患者中，有 91 名患者发生了 BM（2.5%）。63 例（69%）可获得种系突变状态；其中 21 例（35%）携带 BRCA1/2 突变（15 例 BRCA1，6 例 BRCA2）。两组间的临床特征相似。BRCA 突变（mBRCA）组的 BM 诊断中位时间为 31 个月（95%CI，22.6-39.4），野生型 BRCA（wtBRCA）组为 32 个月（95%CI，23.7-40.3）（p=0.78）。48%（n=10）的 mBRCA 和 19%（n=8）的 wtBRCA 患者（p=0.02）在 BM 诊断时 BM 是唯一的疾病证据。根据突变状态，BM 的治疗无差异（p=0.84）。从 BM 诊断时开始的生存时间为 mBRCA 患者 29 个月（95%CI，15.5-42.5），wtBRCA 患者 9 个月（95%CI，5.5-12.5），调整后的风险比（HR）为 0.53，p=0.09；95%CI，0.25-1.11。HR 根据 BM 诊断时是否存在全身疾病进行了调整。
这是迄今为止最大的一项研究，比较了 EOC 和 BM 患者按突变状态的结果。mBRCA 患者更有可能发生孤立性 BM，这可能是其长期生存的一个因素。这支持对发生 BM 的 mBRCA 卵巢癌患者进行积极治疗。需要进一步研究来检查 BRCA 突变状态与 BM 的相关性。
