Liu Taoran, Yu Jing, Gao Yangyang, Ma Xinyang, Jiang Shan, Gu Yuanyuan, Ming Wai-Kit
Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong 999077, China.
Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia.
Cancers (Basel). 2023 Dec 24;16(1):103. doi: 10.3390/cancers16010103.
Hereditary breast and ovarian cancers (HBOCs) pose significant health risks worldwide and are mitigated by prophylactic interventions. However, a meta-analysis of their efficacy and the impact of different genetic variants on their effectiveness is lacking.
A systematic review and meta-analysis were conducted, adhering to Cochrane guidelines. The review encompassed studies that involved prophylactic interventions for healthy women with BRCA variants, focusing on cancer incidence and mortality outcomes. The Newcastle-Ottawa Scale was used for risk of bias assessment. We pooled the extracted outcomes using random effects models and conducted subgroup analyses stratified by intervention, variant, and cancer types.
A total of 21 studies met the inclusion criteria. The meta-analysis revealed that prophylactic interventions significantly reduced cancer risk and mortality. The subgroup analysis showed a greater protective effect for BRCA2 than BRCA1 variant carriers. Risk-reducing surgeries (RRS) were more effective than chemoprevention, with RRS notably reducing cancer risk by 56% compared to 39% for chemoprevention. Prophylactic oophorectomy significantly reduced HBOC risks, while the effect of prophylactic mastectomy and chemoprevention on mortality was less conclusive.
Prophylactic interventions significantly reduce the risk of HBOC and associated mortality. This comprehensive analysis provides insights for future economic evaluations and clinical decision-making in HBOC interventions.
遗传性乳腺癌和卵巢癌（HBOCs）在全球范围内构成重大健康风险，预防性干预措施可降低这些风险。然而，目前缺乏对其疗效以及不同基因变异对其有效性影响的荟萃分析。
按照Cochrane指南进行系统评价和荟萃分析。该评价纳入了针对携带BRCA变异的健康女性进行预防性干预的研究，重点关注癌症发病率和死亡率结局。采用纽卡斯尔-渥太华量表进行偏倚风险评估。我们使用随机效应模型汇总提取的结局，并按干预措施、变异类型和癌症类型进行亚组分析。
共有21项研究符合纳入标准。荟萃分析表明，预防性干预措施显著降低了癌症风险和死亡率。亚组分析显示，BRCA2变异携带者比BRCA1变异携带者的保护作用更大。降低风险的手术（RRS）比化学预防更有效，RRS显著降低癌症风险56%，而化学预防为39%。预防性卵巢切除术显著降低了HBOC风险，而预防性乳房切除术和化学预防对死亡率的影响则不太明确。
预防性干预措施显著降低了HBOC风险及相关死亡率。这一综合分析为未来HBOC干预措施的经济学评估和临床决策提供了见解。
