Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation.-猫眼课题宝

DOI：

10.1097/01.ogx.0000251480.69322.50

发表时间：

2006-07

期刊：

JAMA

影响因子：

通讯作者：

中科院分区：

其他

文献类型：

作者：

A. Finch;M. Beiner;J. Lubiński;H. Lynch;P. Møller;B. Rosen;Joan Murphy;P. Ghadirian;E. Friedman;W. Foulkes;C. Kim-sing;T. Wagner;N. Tung;F. Couch;D. Stoppa-Lyonnet;P. Ainsworth;M. Daly;B. Pasini;R. Gershoni-baruch;C. Eng;O. Olopade;Jane McLennan;B. Karlan;J. Weitzel;P. Sun;S. Narod

背景：BRCA1或BRCA2突变的女性通常被建议进行预防性卵巢切除术。该干预措施的有效性尚未在大型队列中进行前瞻性评估。目的评估携带BRCA1或BRCA2有害突变的女性卵巢癌、输卵管癌和原发性腹膜癌的发生率。评估双侧预防性输卵管-卵巢切除术对这些癌症风险的降低。设计、环境和参与者从1992年至2003年的一项国际登记中发现了携带BRCA1或BRCA2突变的女性。在加拿大、美国、欧洲和以色列的32个中心中的1个，共有1828名携带者完成了基线和随访问卷调查。从研究开始之日起对参与者进行观察，直到：卵巢癌、输卵管癌或腹膜癌的诊断；死亡;或者最近一次跟进的日期。参与者被分为两组，一组接受了双侧预防性卵巢切除术，另一组没有。主要结局指标：通过生存分析确定卵巢癌、腹膜癌和输卵管癌的发生率。通过对协变量进行调整的时间依赖生存分析来评估预防性输卵管-卵巢切除术相关的风险降低。结果：在平均3.5年的随访后，该队列中报告了50例卵巢癌、输卵管癌和腹膜癌。在1828名女性中，555名（30%）在进入研究前接受了双侧预防性输卵管卵巢切除术，490名（27%）在进入研究后接受了该手术，783名（43%）未接受该手术。在卵巢完好的女性中，有32例癌症被诊断出来（每年1015/ 100000）。11例在预防性卵巢切除术时被发现，7例在预防性卵巢切除术后被诊断出来（217/10万/年）。估计在卵巢切除术后20年腹膜癌的累积发病率为4.3%。双侧卵巢切除术相关的总体（调整后）癌症风险降低80%（多因素风险比= 0.20；95%可信区间，0.07-0.58;P = 0.003）。结论：尽管预防性输卵管-卵巢切除术后BRCA1和BRCA2突变携带者的腹膜癌残留风险很大，但卵巢切除术与高危女性卵巢癌和输卵管癌的风险降低相关。

CONTEXT Women with BRCA1 or BRCA2 mutation are often advised to undergo preventive oophorectomy. The effectiveness of this intervention has not been prospectively evaluated in a large cohort. OBJECTIVES To estimate the incidence of ovarian, fallopian tube, and primary peritoneal cancer in women who carry a deleterious mutation in BRCA1 or BRCA2. To estimate the reduction in risk of these cancers associated with a bilateral prophylactic salpingo-oophorectomy. DESIGN, SETTING, AND PARTICIPANTS Women known to carry a BRCA1 or BRCA2 mutation were identified from an international registry between 1992 and 2003. A total of 1828 carriers at 1 of 32 centers in Canada, the United States, Europe, and Israel completed questionnaires at baseline and follow-up. Participants were observed from the date of study entry until: diagnosis of ovarian, fallopian tube, or peritoneal cancer; death; or the date of the most recent follow-up. INTERVENTION Participants were divided into women who had undergone bilateral prophylactic oophorectomy and those who had not. MAIN OUTCOME MEASURE The incidence of ovarian, peritoneal, and fallopian tube cancer was determined by survival analysis. The risk reduction associated with prophylactic salpingo-oophorectomy was evaluated by a time-dependent survival analysis, adjusting for covariates. RESULTS After a mean follow-up of 3.5 years, 50 incident ovarian, fallopian tube, and peritoneal cancer cases were reported in the cohort. Of the 1828 women, 555 (30%) underwent a bilateral prophylactic salpingo-oophorectomy prior to study entry, 490 (27%) underwent the procedure after entering the study, and 783 (43%) did not undergo the procedure. There were 32 incident cancers diagnosed in women with intact ovaries (1015/100,000 per year). Eleven cancer cases were identified at the time of prophylactic oophorectomy and 7 were diagnosed following prophylactic oophorectomy (217/100,000 per year). The estimated cumulative incidence of peritoneal cancer is 4.3% at 20 years after oophorectomy. The overall (adjusted) reduction in cancer risk associated with bilateral oophorectomy is 80% (multivariate hazard ratio = 0.20; 95% confidence interval, 0.07-0.58; P = .003). CONCLUSION Oophorectomy is associated with reduced risk of ovarian and fallopian tube cancer in high-risk women, although there is a substantial residual risk for peritoneal cancer in BRCA1 and BRCA2 mutation carriers following prophylactic salpingo-oophorectomy.

Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation.

文献摘要

被引文献

相似文献