Survival Analysis of Cancer Risk Reduction Strategies for BRCA1/2 Mutation Carriers
Survival Analysis of Cancer Risk Reduction Strategies for BRCA1/2 Mutation Carriers
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DOI：
10.1200/jco.2009.22.7991
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发表时间：
2010-01-10
影响因子：
45.3
通讯作者：
Plevritis, Sylvia K.
中科院分区：
文献类型：
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作者：
Kurian, Allison W.;Sigal, Bronislava M.;Plevritis, Sylvia K.
BRCA 1/2突变的女性遗传了乳腺癌和卵巢癌的高风险;降低癌症死亡率的选择包括预防性手术或乳腺筛查，但它们的疗效从未进行过经验性比较。我们使用决策分析来模拟BRCA 1/2突变携带者的风险降低策略，并比较由此产生的生存概率和死亡原因。MethodsWe开发了一个Monte Carlo模型，从25岁到69岁，每年进行乳房X光检查加磁共振成像（MRI），在不同年龄进行预防性乳房切除术（PM），和/或预防性卵巢切除术（PO）在40或50岁的25岁的BRCA 1/2突变carriers.ResultsWith无干预，生存概率70岁的BRCA 1和71%的BRCA 2突变carriers. ResultsWith 53%。BRCA 1突变携带者最有效的单一干预是40岁时的PO，产生15%的绝对生存增益;对于BRCA 2突变携带者，最有效的单一干预是PM，如果在40岁时进行，产生7%的生存增益。在40岁时，PM和PO的组合比任何单一干预措施都能提高生存率，BRCA 1突变携带者的生存率提高了24%，BRCA 2突变携带者提高了11%。PM在25岁，而不是40岁，提供最小的增量效益（1%至2%）;替代筛选PM产生同样最小的递减生存率（2%至3%）。ConclusionAlthough PM在25岁加PO在40岁时最大化生存概率，替代乳腺X线摄影加MRI筛选PM似乎提供可比的生存率。这些结果可以指导BRCA 1/2突变的女性在预防性手术和乳腺筛查之间做出选择。
PurposeWomen with BRCA1/2 mutations inherit high risks of breast and ovarian cancer; options to reduce cancer mortality include prophylactic surgery or breast screening, but their efficacy has never been empirically compared. We used decision analysis to simulate risk-reducing strategies in BRCA1/2 mutation carriers and to compare resulting survival probability and causes of death.MethodsWe developed a Monte Carlo model of breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years, prophylactic mastectomy (PM) at various ages, and/or prophylactic oophorectomy (PO) at ages 40 or 50 years in 25-year-old BRCA1/2 mutation carriers.ResultsWith no intervention, survival probability by age 70 is 53% for BRCA1 and 71% for BRCA2 mutation carriers. The most effective single intervention for BRCA1 mutation carriers is PO at age 40, yielding a 15% absolute survival gain; for BRCA2 mutation carriers, the most effective single intervention is PM, yielding a 7% survival gain if performed at age 40 years. The combination of PM and PO at age 40 improves survival more than any single intervention, yielding 24% survival gain for BRCA1 and 11% for BRCA2 mutation carriers. PM at age 25 instead of age 40 offers minimal incremental benefit (1% to 2%); substituting screening for PM yields a similarly minimal decrement in survival (2% to 3%).ConclusionAlthough PM at age 25 plus PO at age 40 years maximizes survival probability, substituting mammography plus MRI screening for PM seems to offer comparable survival. These results may guide women with BRCA1/2 mutations in their choices between prophylactic surgery and breast screening.