Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Int J Gynecol Cancer. 2024 Jan 5;34(1):88-98. doi: 10.1136/ijgc-2023-004980.
To evaluate disease characteristics and survival according to status, administration of poly-(ADP-ribose) polymerase inhibitors (PARPi), and surgery in patients with ovarian cancer and brain metastases.
This is a monocentric retrospective cohort of patients with ovarian cancer and brain metastases treated between 2000 and 2021. Data were collected by a retrospective review of medical records and analyzed according to: (1) mutation; (2) PARPi before and after brain metastases; (3) surgery for brain metastases.
Eighty-five patients with ovarian cancer and brain metastasis and known status (31 mutated (m), 54 wild-type (wt)) were analyzed. Twenty-two patients had received PARPi before brain metastases diagnosis (11 m, 11 wt) and 12 after (8 m, 4 wt). Brain metastases occurred >1 year later in patients who had received previous PARPi. Survival was longer in the m group (median post-brain metastasis survival: m 23 months vs wt 8 months, p=0.0015). No differences were found based on status analyzing the population who did not receive PARPi after brain metastasis (median post-brain metastasis survival: m 8 months vs wt 8 months, p=0.31). In the m group, survival was worse in patients who had received previous PARPi (median post-brain metastasis survival: PARPi before, 7 months vs no-PARPi before, 24 months, p=0.003). If PARPi was administered after brain metastases, survival of the overall population improved (median post-brain metastasis survival: PARPi after, 46 months vs no-PARPi after, 8 months, p=0.00038).In cases of surgery for brain metastases, the prognosis seemed better (median post-brain metastasis survival: surgery 13 months vs no-surgery 8 months, p=0.036). Three variables were significantly associated with prolonged survival at multivariate analysis: mutation, multimodal treatment, and ≤1 previous chemotherapy line.
mutations might impact brain metastasis occurrence and lead to better outcomes. In a multimodal treatment, surgery seems to affect survival even in cases of extracranial disease. PARPi use should be considered as it seems to prolong survival if administered after brain metastasis.
评估卵巢癌脑转移患者的生存情况，依据 BRCA 状态、聚 ADP 核糖聚合酶抑制剂（PARPi）的使用情况和手术治疗情况。
这是一项回顾性单中心队列研究，纳入了 2000 年至 2021 年期间接受治疗的卵巢癌脑转移患者。通过回顾病历收集数据，并根据以下因素进行分析：（1）BRCA 突变状态；（2）脑转移前和脑转移后的 PARPi 使用情况；（3）脑转移灶的手术治疗情况。
共分析了 85 例已知 BRCA 状态（31 例突变型（m），54 例野生型（wt））的卵巢癌脑转移患者。22 例患者在脑转移诊断前接受过 PARPi（11 例 m，11 例 wt），12 例在脑转移后接受过 PARPi（8 例 m，4 例 wt）。在接受过 PARPi 的患者中，脑转移发生的时间更晚。m 组的生存时间更长（脑转移后中位生存时间：m 23 个月 vs wt 8 个月，p=0.0015）。在未接受脑转移后 PARPi 的患者中，根据 BRCA 状态分析，未发现生存差异（脑转移后中位生存时间：m 8 个月 vs wt 8 个月，p=0.31）。在 m 组中，接受过 PARPi 的患者生存更差（脑转移后中位生存时间：PARPi 治疗前，7 个月 vs 无 PARPi 治疗前，24 个月，p=0.003）。如果脑转移后给予 PARPi，则总体人群的生存时间改善（脑转移后中位生存时间：PARPi 治疗后，46 个月 vs 无 PARPi 治疗后，8 个月，p=0.00038）。如果行脑转移灶手术治疗，预后似乎更好（脑转移后中位生存时间：手术治疗 13 个月 vs 无手术治疗 8 个月，p=0.036）。多变量分析显示，3 个变量与延长生存时间显著相关：BRCA 突变、多模式治疗和≤1 线化疗。
BRCA 突变可能影响脑转移的发生，并导致更好的结局。在多模式治疗中，即使存在颅外疾病，手术似乎也能影响生存。如果在脑转移后使用 PARPi，似乎可以延长生存时间，因此应考虑使用 PARPi。
