Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations
Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations
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DOI：
10.1056/nejmoa012158
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发表时间：
2002-05-23
影响因子：
158.5
通讯作者：
Weber, BL
中科院分区：
文献类型：
--
作者：
Rebbeck, TR;Lynch, HT;Weber, BL
背景：关于双侧预防性卵巢切除术降低BRCA1或BRCA2突变女性妇科癌症风险的有效性的数据有限。我们调查了这种方法是否能降低携带这种突变的女性患体腔上皮癌和乳腺癌的风险。方法：从登记处共鉴定出551名患有疾病相关生殖系BRCA1或BRCA2突变的妇女，并研究卵巢癌和乳腺癌的发生。我们确定了259名接受双侧预防性卵巢切除术的妇女和292名未接受该手术的对照组的卵巢癌发病率。在241名没有乳腺癌病史或预防性乳房切除术的女性亚组中，确定了99名接受双侧预防性卵巢切除术的女性和142名匹配对照女性的乳腺癌发病率。两组患者术后随访时间均在8年以上。结果：6名接受预防性卵巢切除术的妇女（2.3%）在手术时被诊断为I期卵巢癌；两名女性（0.8%）在双侧预防性卵巢切除术后3.8年和8.6年被诊断为乳头状浆液性腹膜癌。在对照组中，58名女性（19.9%）在平均8.8年的随访后被诊断为卵巢癌。排除6名手术诊断为癌症的妇女后，预防性卵巢切除术显著降低了患体腔上皮癌的风险（风险比为0.04；95%可信区间为0.01至0.16）。在99名接受双侧预防性卵巢切除术的女性中，有21人（21.2%）患乳腺癌，而对照组中有60人（42.3%）患乳腺癌（风险比0.47；95%可信区间0.29至0.77）。结论：双侧预防性卵巢切除术可降低BRCA1或BRCA2突变女性患体腔上皮癌和乳腺癌的风险。（中华医学杂志2002；346:1616-22）版权所有(C) 2002马萨诸塞州医学协会。
Background: Data concerning the efficacy of bilateral prophylactic oophorectomy for reducing the risk of gynecologic cancer in women with BRCA1 or BRCA2 mutations are limited. We investigated whether this procedure reduces the risk of cancers of the coelomic epithelium and breast in women who carry such mutations.Methods: A total of 551 women with disease-associated germ-line BRCA1 or BRCA2 mutations were identified from registries and studied for the occurrence of ovarian and breast cancer. We determined the incidence of ovarian cancer in 259 women who had undergone bilateral prophylactic oophorectomy and in 292 matched controls who had not undergone the procedure. In a subgroup of 241 women with no history of breast cancer or prophylactic mastectomy, the incidence of breast cancer was determined in 99 women who had undergone bilateral prophylactic oophorectomy and in 142 matched controls. The length of postoperative follow-up for both groups was at least eight years.Results: Six women who underwent prophylactic oophorectomy (2.3 percent) received a diagnosis of stage I ovarian cancer at the time of the procedure; two women (0.8 percent) received a diagnosis of papillary serous peritoneal carcinoma 3.8 and 8.6 years after bilateral prophylactic oophorectomy. Among the controls, 58 women (19.9 percent) received a diagnosis of ovarian cancer, after a mean follow-up of 8.8 years. With the exclusion of the six women whose cancer was diagnosed at surgery, prophylactic oophorectomy significantly reduced the risk of coelomic epithelial cancer (hazard ratio, 0.04; 95 percent confidence interval, 0.01 to 0.16). Of 99 women who underwent bilateral prophylactic oophorectomy and who were studied to determine the risk of breast cancer, breast cancer developed in 21 (21.2 percent), as compared with 60 (42.3 percent) in the control group (hazard ratio, 0.47; 95 percent confidence interval, 0.29 to 0.77).Conclusions: Bilateral prophylactic oophorectomy reduces the risk of coelomic epithelial cancer and breast cancer in women with BRCA1 or BRCA2 mutations. (N Engl J Med 2002;346:1616-22.) Copyright (C) 2002 Massachusetts Medical Society.