BRCA1/2 基因突变携带者预防性切除卵巢对乳腺癌患者生存的影响

The impact of oophorectomy on survival from breast cancer in patients with CHEK2 mutations.

机构信息

Department of Histology, Department of Biology and Genetics, Faculty of Medicine, University of Opole, Opole, Poland.

Department of Surgery and Oncology, University of Zielona Góra, Zyty 28 St, 65-046, Zielona Góra, Poland.

出版信息

Br J Cancer. 2022 Jul;127(1):84-91. doi: 10.1038/s41416-022-01770-1. Epub 2022 Mar 7.

DOI:10.1038/s41416-022-01770-1

PMID:35256754

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9276789/

Abstract

BACKGROUND

To estimate the impact of oophorectomy and other treatments on the survival of breast cancer patients with a CHEK2 mutation.

METHODS

Women with Stage I-III breast cancer who were treated at 17 hospitals in Poland were tested for four founder mutations in the CHEK2 gene. 974 women (10%) were positive for a CHEK2 mutation. Control patients without a CHEK2 mutation were selected from a database of patients treated over the same time period. Information on treatments received and distant recurrences were retrieved from medical records. Treatments included chemotherapy, hormonal therapy (tamoxifen) and radiation therapy. Oophorectomies were performed for the treatment of breast cancer or for benign conditions. Dates of death were obtained from the Polish Vital Statistics Registry. Causes of death were determined by medical record review. Predictors of survival were determined using the Cox proportional hazards model.

RESULTS

In all, 839 patients with a CHEK2 mutation were matched to 839 patients without a mutation. The mean follow-up was 12.0 years. The 15-year survival for CHEK2 carriers was 76.6% and the 15-year survival for non-carrier control patients was 78.8% (adjusted HR = 1.06; 95% CI: 0.84-1.34; P = 0.61). Among CHEK2 carriers, the 15-year survival for women who had an oophorectomy was 86.3% and for women who did not have an oophorectomy was 72.1% (adjusted HR = 0.59; 95% CI: 0.38-0.90; P = 0.02). Among controls, the 15-year survival for patients who had an oophorectomy was 84.5% and for women who did not have an oophorectomy was 77.6% (adjusted HR = 1.03; 95% CI: 0.66-1.61; P = 0.90).

CONCLUSION

Among women with breast cancer and a CHEK2 mutation, oophorectomy is associated with a reduced risk of death from breast cancer.

摘要

背景

评估卵巢切除术和其他治疗方法对携带 CHEK2 突变的乳腺癌患者生存的影响。

方法

在波兰的 17 家医院接受治疗的 I-III 期乳腺癌女性接受了 CHEK2 基因的四个创始人突变检测。974 名女性（10%）检测出 CHEK2 突变阳性。选择数据库中在同一时期接受治疗的无 CHEK2 突变的对照患者。从病历中检索接受的治疗和远处复发的信息。治疗包括化疗、激素治疗（他莫昔芬）和放射治疗。卵巢切除术用于治疗乳腺癌或良性疾病。从波兰生命统计登记处获得死亡日期。通过病历审查确定死亡原因。使用 Cox 比例风险模型确定生存的预测因素。

结果

总共，839 名携带 CHEK2 突变的患者与 839 名无突变的患者相匹配。平均随访时间为 12.0 年。CHEK2 携带者的 15 年生存率为 76.6%，非携带者对照患者的 15 年生存率为 78.8%（调整后的 HR=1.06；95%CI：0.84-1.34；P=0.61）。在 CHEK2 携带者中，行卵巢切除术的女性 15 年生存率为 86.3%，未行卵巢切除术的女性为 72.1%（调整后的 HR=0.59；95%CI：0.38-0.90；P=0.02）。在对照组中，行卵巢切除术的患者 15 年生存率为 84.5%，未行卵巢切除术的患者为 77.6%（调整后的 HR=1.03；95%CI：0.66-1.61；P=0.90）。