Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands.
J Clin Oncol. 2022 Jun 10;40(17):1879-1891. doi: 10.1200/JCO.21.02016. Epub 2022 Mar 18.
After risk-reducing salpingo-oophorectomy (RRSO), / pathogenic variant (PV) carriers have a residual risk to develop peritoneal carcinomatosis (PC). The etiology of PC is not yet clarified, but may be related to serous tubal intraepithelial carcinoma (STIC), the postulated origin for high-grade serous cancer. In this systematic review and individual patient data meta-analysis, we investigate the risk of PC in women with and without STIC at RRSO.
Unpublished data from three centers were supplemented by studies identified in a systematic review of EMBASE, MEDLINE, and the Cochrane library describing women with a -PV with and without STIC at RRSO until September 2020. Primary outcome was the hazard ratio for the risk of PC between -PV carriers with and without STIC at RRSO, and the corresponding 5- and 10-year risks. Primary analysis was based on a one-stage Cox proportional-hazards regression with a frailty term for study.
From 17 studies, individual patient data were available for 3,121 women, of whom 115 had a STIC at RRSO. The estimated hazard ratio to develop PC during follow-up in women with STIC was 33.9 (95% CI, 15.6 to 73.9), < .001) compared with women without STIC. For women with STIC, the five- and ten-year risks to develop PC were 10.5% (95% CI, 6.2 to 17.2) and 27.5% (95% CI, 15.6 to 43.9), respectively, whereas the corresponding risks were 0.3% (95% CI, 0.2 to 0.6) and 0.9% (95% CI, 0.6 to 1.4) for women without STIC at RRSO.
-PV carriers with STIC at RRSO have a strongly increased risk to develop PC which increases over time, although current data are limited by small numbers of events.
在进行降低风险的输卵管卵巢切除术（RRSO）后，/致病性变异（PV）携带者仍有发生腹膜癌（PC）的残余风险。PC 的病因尚不清楚，但可能与输卵管上皮内癌（STIC）有关，STIC 被认为是高级别浆液性癌的起源。在这项系统评价和个体患者数据荟萃分析中，我们调查了 RRSO 时存在和不存在 STIC 的 PV 携带者发生 PC 的风险。
对三个中心的未发表数据进行补充，并对 EMBASE、MEDLINE 和 Cochrane 图书馆中描述的在 RRSO 时存在和不存在 STIC 的具有-aPV 的女性的研究进行系统回顾，检索时间截至 2020 年 9 月。主要结局是 RRSO 时存在和不存在 STIC 的-PV 携带者发生 PC 的风险的风险比（HR），以及相应的 5 年和 10 年风险。主要分析基于一阶段 Cox 比例风险回归，具有研究的脆弱性项。
从 17 项研究中，3121 名女性的个体患者数据可用，其中 115 名在 RRSO 时存在 STIC。在随访期间，患有 STIC 的女性发生 PC 的估计 HR 为 33.9（95%CI，15.6 至 73.9），<.001）与没有 STIC 的女性相比。对于患有 STIC 的女性，发生 PC 的 5 年和 10 年风险分别为 10.5%（95%CI，6.2 至 17.2）和 27.5%（95%CI，15.6 至 43.9），而 RRSO 时没有 STIC 的女性的相应风险分别为 0.3%（95%CI，0.2 至 0.6）和 0.9%（95%CI，0.6 至 1.4）。
RRSO 时存在 STIC 的-PV 携带者发生 PC 的风险显著增加，且随着时间的推移而增加，尽管目前的数据受到事件数量较少的限制。
