Overall survival and clinical characteristics of BRCA mutation carriers with stage I/II pancreatic cancer.
Overall survival and clinical characteristics of BRCA mutation carriers with stage I/II pancreatic cancer.
复制标题
DOI：
10.1038/bjc.2017.19
复制
发表时间：
2017-03-14
影响因子：
8.8
通讯作者：
Gallinger S
中科院分区：
文献类型：
--
作者：
Golan T;Sella T;O'Reilly EM;Katz MH;Epelbaum R;Kelsen DP;Borgida A;Maynard H;Kindler H;Friedmen E;Javle M;Gallinger S
BRCA1/BRCA2生殖系(GL)突变携带者合并胰腺癌(PDAC)可能有不同的预后。我们最近在一项单臂、非对照、回顾性研究中描述了手术切除的BRCA相关的PDAC患者的明显更有利的预后。然而，手术切除的PDAC中GL BRCA1/2突变对预后的影响尚未与匹配的对照组人群进行比较。进行了一项更大规模的多中心病例对照回顾分析。病例为2004-2013年间手术切除的BRCA1/2相关PDAC患者。对照组包括在同一时期接受手术切除的PDAC病例，这些病例要么是BRCA非携带者，要么是没有乳腺癌、卵巢癌或胰腺癌家族史的患者。病例和对照按以下方面匹配：确诊时的年龄(在±5年内)和机构。从患者记录中提取人口学数据、临床病史、总生存期(OS)和无病生存期(DFS)。统计学比较采用χ2-和Fisher‘s精确检验，中位数DFS/OS采用Kaplan-Meier法和对数等级检验。25例BRCA1-(n=4)或BRCA2(N=21)相关的PDAC患者被确定为可切除的。平均年龄55.7岁(34-78岁)，女性占48%(n=12)，犹太人占76%(n=19)。2例(1例 ： )与49例可切除的PDAC对照进行比较，并平衡了年龄、种族和其他相关的临床和病理特征。BRCA相关的PDAC患者接受新辅助或以铂为基础的辅助治疗的频率分别高于对照组(8例中7例对14例中6例)和(21例中7例对44例中3例)。中位OS(37.06月vs38.77月，P=0.838)和DFS(14.3月vs12.0月，P=0.303)在病例组和对照组之间差异无统计学意义。在接受新辅助/含铂方案治疗的BRCA阳性患者(n=10)中，与类似治疗的对照组(n=7)相比(39.1比12.4个月，P=0.255)，DFS有增加的趋势。在这项回顾分析中，可手术切除的BRCA相关性PDAC的预后与同一机构的散发性PDAC没有什么不同。以铂为基础的辅助治疗在这种情况下的作用需要进行前瞻性研究。
BRCA1/BRCA2 germ line (GL) mutation carriers with pancreatic adenocarcinoma (PDAC) may have distinct outcomes. We recently described an apparent more favourable prognosis of surgically resected BRCA-associated PDAC patients in a single-arm, uncontrolled, retrospective study. However, the prognostic impact of GL BRCA1/2 mutations in surgically resected PDAC has not been compared with a matched control population. A larger multi-centre, case–control retrospective analysis was performed. Cases were patients with surgically resected, BRCA1/2-associated PDAC from 2004 to 2013. Controls included surgically resected PDAC cases treated during the same time period that were either BRCA non-carriers, or had no family history of breast, ovarian or pancreatic cancers. Cases and controls were matched by: age at diagnosis (within ±5-year period) and institution. Demographics, clinical history, overall survival (OS) and disease-free survival (DFS) were abstracted from patient records. Statistical comparisons were assessed using χ2- and Fisher's exact test, and median DFS/OS using Kaplan–Meier method and log-rank testing. Twenty-five patients with BRCA1-(n=4) or BRCA2 (N=21)-associated resectable PDAC were identified. Mean age was 55.7 years (range, 34–78 years), 48% (n=12) were females and 76% (n=19) were Jewish. Cases were compared (1 : 2) with 49 resectable PDAC controls, and were balanced for age, ethnicity and other relevant clinical and pathological features. BRCA-associated PDAC patients received neoadjuvant, or adjuvant platinum-based treatment more frequently than controls (7 out of 8 vs 6 out of 14) and (7 out of 21 vs 3 out of 44), respectively. No significant difference in median OS (37.06 vs 38.77 months, P=0.838) and in DFS (14.3 vs 12.0 months, P=0.303) could be demonstrated between cases and controls. A trend to increased DFS was observed among BRCA-positive cases treated with neoadjuvant/adjuvant platinum-containing regimens (n=10) compared with similarly treated controls (n=7) (39.1 vs 12.4 months, P=0.255). In this retrospective analysis, the prognosis of surgically resectable BRCA-associated PDAC is no different than that of sporadic PDAC from the same institution. The role of platinum-based adjuvant therapy in this setting requires prospective investigation.