Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations:: A decision analysis
Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations:: A decision analysis
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DOI：
10.1200/jco.2004.06.090
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发表时间：
2004-03-15
影响因子：
45.3
通讯作者：
Weber, B
中科院分区：
文献类型：
--
作者：
Armstrong, K;Schwartz, JS;Weber, B
目的：对许多携带BRCA 1/2突变的绝经前妇女，由于对卵巢切除术后激素替代治疗（HRT）的关注和争议，决定是否进行预防性卵巢切除术是困难的。患者和方法：使用最新的流行病学数据，采用马尔可夫决策分析模型评估预防性卵巢切除术联合或不联合HRT的预期结果（至50岁或终身）在BRCA 1/2突变的女性队列中。进行敏感性分析，以评估替代假设的影响，HRT的影响，预防性卵巢切除术的影响，以及与BRCA 1/2突变相关的癌症风险。结果在我们的模型中，预防性卵巢切除术延长了BRCA 1/2突变妇女的预期寿命，无论是否在卵巢切除术后使用HRT，这一增益范围为3.34至4.65年，取决于卵巢切除术的年龄。卵巢切除术后使用HRT与50岁时停止HRT时预期寿命的相对较小变化（+0.17至-0.34岁）相关，但如果HRT持续终身，则预期寿命下降较大（-0.79至-1.09岁）。HRT与接受预防性乳房切除术和卵巢切除术的突变携带者的预期寿命增加0.39和0.79年之间。结论根据本决策分析的结果，我们建议BRCA 1/2突变的妇女在生育结束后接受预防性卵巢切除术。卵巢切除术后短期HRT的决定主要基于生活质量问题，而不是预期寿命，如果使用HRT，考虑在预期自然绝经时（约50岁）停止治疗。(C)2004年，美国临床肿瘤学会。
Purpose The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy.Patients and Methods A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations.Results In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy, This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to -0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (-0.79 to -1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy.Conclusion On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years. (C) 2004 by American Society of Clinical Oncology.