Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.
Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.
Eur J Surg Oncol. 2019 Nov;45(11):2096-2102. doi: 10.1016/j.ejso.2019.06.023. Epub 2019 Jun 13.
To describe accurately the oncological outcomes after hepatic resection (HR) in recurrent ovarian carcinoma (ROC) evaluating clinic-pathological variables and mutational status of BRCA1/2. Although HR is considered a challenging situation in ROC patients, assessment of BRCA1/2 mutational status seems to have a relevant clinical value to guide surgical therapy.
Patients who underwent HR for ROC at the Catholic University of Rome, between June 2012 and October 2017 were included. Exclusion criteria were represented by extra-abdominal disease and presence of diffuse peritoneal carcinomatosis requiring more than 2 bowel resections. Details relative to HR were collected and BRCA analysis was performed. Predictive factors of post-HR progression free survival (PHR-PFS) were assessed by univariate analyses using Cox-proportional hazard regression models.
Thirty-four patients undewent HR within secondary cytoreductive surgery (SCS). Six patients (17.6%) presented with hepatic relapse only, while the remaining 28 patients (82.4%) had concomitant extra-hepatic disease. In the whole series, the 3-yr PHR-PFS was 49.1% and the 3-yr post-HR overall survival was 72.9%. Univariate analysis of variables conditioning PHR-PFS showed that only BRCA mutational status played a statistically significant favourable role: the 3-yr PHR-PFS rate was 81.0% in BRCA mutated patient compared to 15.2% in wild type ones (p value: 0.001).
Our clinical analyses suggest that in ROC patients with liver disease the assessment of germline and somatic BRCA mutational status can help to select patients elegible for SCS.
描述复发性卵巢癌（ROC）患者行肝切除（HR）后的肿瘤学结局，评估临床病理变量和 BRCA1/2 的突变状态。尽管 HR 被认为是 ROC 患者的一种具有挑战性的情况，但评估 BRCA1/2 突变状态似乎具有重要的临床价值，可以指导手术治疗。
纳入 2012 年 6 月至 2017 年 10 月在罗马天主教大学行 HR 治疗的 ROC 患者。排除标准为存在腹外疾病和需要超过 2 次肠切除术的弥漫性腹膜癌病。收集了与 HR 相关的详细信息，并进行了 BRCA 分析。使用 Cox 比例风险回归模型的单因素分析评估了 HR 后无进展生存期（PHR-PFS）的预测因素。
34 例患者在二次细胞减灭术（SCS）中接受 HR。6 例（17.6%）仅存在肝复发，而其余 28 例（82.4%）同时存在肝外疾病。在整个系列中，3 年 PHR-PFS 为 49.1%，3 年 HR 总生存率为 72.9%。影响 PHR-PFS 的单因素变量分析表明，只有 BRCA 突变状态具有统计学意义的有利作用：BRCA 突变患者的 3 年 PHR-PFS 率为 81.0%，而野生型患者为 15.2%（p 值：0.001）。
我们的临床分析表明，在有肝疾病的 ROC 患者中，评估种系和体细胞 BRCA 突变状态可以帮助选择适合 SCS 的患者。
