Gynecologic surgeries and risk of ovarian cancer in women with BRCA1 and BRCA2 Ashkenazi founder mutations: An Israeli population-based case-control study
Gynecologic surgeries and risk of ovarian cancer in women with BRCA1 and BRCA2 Ashkenazi founder mutations: An Israeli population-based case-control study
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DOI：
10.1093/jnci/95.14.1072
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发表时间：
2003-07-16
影响因子：
10.3
通讯作者：
Hartge, P
中科院分区：
文献类型：
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作者：
Rutter, JL;Wacholder, S;Hartge, P
背景资料：在一般人群中，经历输卵管结扎、子宫切除术或卵巢切除术的女性发生卵巢癌的风险降低，尽管双侧卵巢切除术后可能发生腹膜癌。在遗传筛查诊所的研究中，发现乳腺和卵巢易感基因BRCA 1和BRCA 2突变的妇女在双侧卵巢切除术后的头几年患腹膜癌的风险较低。我们评估了携带BRCA1/2突变但未从高风险诊所选择的女性在妇科手术后卵巢（包括腹膜）癌风险降低的水平和持续性。研究方法：我们确定了1124名以色列妇女的卵巢癌或原发性腹膜癌，并测试了其中847人的三个德系犹太人创始人突变。我们比较了所有病例患者、BRCA 1（n = 187）和BRCA 2（n = 64）携带者病例患者以及非携带者病例患者（n = 598）与来自人群登记的对照受试者（n = 2396）的妇科手术史。我们用逻辑回归模型估计了突变携带者和非携带者妇科手术后卵巢癌的风险（比值比[OR]和95%置信区间[CI]）。结果如下：8例原发性腹膜癌患者和128例对照组受试者报告了既往双侧卵巢切除术（OR = 0.12，95%CI = 0.06至0.24）。其他妇科手术与卵巢癌风险降低30%-50%相关，取决于手术类型，手术切除一些卵巢组织与风险降低最相关（OR = 0.34，95%CI = 0.16 - 0.74）。BRCA1/2携带者和非携带者的风险降低。手术时的年龄和手术后的年数对风险降低没有影响。结论：BRCA1/2突变携带者和非携带者在妇科手术后发生卵巢癌或腹膜癌的风险均降低。减少的幅度取决于手术的类型和范围。
Background: In the general population, the risk of developing ovarian cancer is reduced in women who have undergone tubal ligation, hysterectomy, or oophorectomy, although peritoneal cancer can arise after bilateral oophorectomy. In studies from genetic screening clinics, women with mutations in the breast and ovarian susceptibility genes BRCA1 and BRCA2 have been found to have a low risk of peritoneal carcinoma in the first years after bilateral oophorectomy. We assessed the level and persistence of reduction of ovarian (including peritoneal) cancer risk after gynecologic surgeries for women who carry BRCA1/2 mutations but were not selected from high-risk clinics. Methods: We identified 1124 Israeli women with incident ovarian cancer or primary peritoneal cancer and tested 847 of them for the three Ashkenazi founder mutations. We compared gynecologic surgery history among all case patients, BRCA1 (n = 187) and BRCA2 (n = 64) carrier case patients, and the non-carrier case patients (n = 598) with that in control subjects drawn from a population registry (n = 2396). We estimated ovarian cancer risk (odds ratios [ORs] with 95% confidence intervals [CIs]) after gynecologic surgery in mutation carriers and non-carriers with logistic regression models. Results: Eight women with primary peritoneal cancer and 128 control subjects reported a previous bilateral oophorectomy (OR = 0.12, 95% CI = 0.06 to 0.24). Other gynecologic surgeries were associated with a 30%-50% reduced risk of ovarian cancer, depending on the type of surgery, with surgery to remove some ovarian tissue associated with the most risk reduction (OR = 0.34, 95% CI = 0.16 to 0.74). Reduced risks were seen in BRCA1/2 carriers and non-carriers. Age at surgery and years since surgery did not affect risk reductions. Conclusion: Both BRCA1/2 mutation carriers and non-carriers have reduced risk of ovarian or peritoneal cancer after gynecologic surgery. The magnitude of the reduction depends upon the type and extent of surgery.