Jóhannsson O T, Ranstam J, Borg A, Olsson H
Department of Oncology, University Hospital, Lund, Sweden.
J Clin Oncol. 1998 Feb;16(2):397-404. doi: 10.1200/JCO.1998.16.2.397.
Recent studies indicate that BRCA1 breast and ovarian tumors may have an advantageous survival. In this population-based study, the survival of carriers of a mutated BRCA1 gene was investigated.
The survival of 71 BRCA1-associated cancer patients (33 breast cancer, seven breast and ovarian cancer, and 31 ovarian cancer patients from 21 families with BRCA1 germline mutations) diagnosed after 1958 was compared with that of a population-based comparison group that consisted of all other invasive breast (n = 28,281) and ovarian (n = 7,011) cancers diagnosed during 1958 to 1995, as well as an age- and stage-matched control group.
No apparent survival advantage was found for BRCA1-associated breast cancers upon direct comparison. After adjustment for age and calendar year of diagnosis, survival was equal to or worse than that of the comparison group (hazards ratio [HR], 1.5; 95% confidence interval [CI], 0.9 to 2.4). In comparison with an age- and stage-matched control group, survival again appeared equal or worse (HR, 1.5; 95% CI, 0.6 to 3.7). For BRCA1-associated ovarian cancers, an initial survival advantage was noted that disappeared with time. Due to this time dependency, multivariate analyses cannot adequately be analyzed. Compared with the age- and stage-matched control group, survival again appeared equal or worse (HR, 1.2; 95% CI, 0.5 to 2.8).
The results suggest that survival for carriers of a BRCA1 mutation may be similar, or worse than, that for breast and ovarian cancer in general. This finding is in accordance with the adverse histopathologic features observed in BRCA1 tumors and underlines the need for surveillance in families that carry a BRCA1 mutation.
近期研究表明，携带BRCA1基因突变的乳腺癌和卵巢癌患者可能具有生存优势。在这项基于人群的研究中，对携带BRCA1基因突变者的生存情况进行了调查。
将1958年后确诊的71例与BRCA1相关的癌症患者（33例乳腺癌、7例乳腺癌合并卵巢癌、31例卵巢癌患者，来自21个携带BRCA1种系突变的家族）的生存情况与一个基于人群的对照组进行比较，该对照组包括1958年至1995年期间确诊的所有其他浸润性乳腺癌（n = 28281）和卵巢癌（n = 7011）患者，以及一个年龄和分期匹配的对照组。
直接比较时，未发现与BRCA1相关的乳腺癌具有明显的生存优势。在对年龄和诊断年份进行调整后，其生存率等于或低于对照组（风险比[HR]，1.5；95%置信区间[CI]，0.9至2.4）。与年龄和分期匹配的对照组相比，生存率再次显示相同或更低（HR，1.5；95%CI，0.6至3.7）。对于与BRCA1相关的卵巢癌，最初观察到生存优势，但随着时间推移这种优势消失。由于这种时间依赖性，无法充分进行多变量分析。与年龄和分期匹配的对照组相比，生存率再次显示相同或更低（HR，1.2；95%CI，0.5至2.8）。
结果表明，携带BRCA1基因突变者的生存率可能与一般乳腺癌和卵巢癌患者相似或更低。这一发现与BRCA1肿瘤中观察到的不良组织病理学特征一致，并强调了对携带BRCA1基因突变家族进行监测的必要性。
