Abstract
Objectives
The reported incidence of neoplasia identified at the time of risk-reducing salpingo-oophorectomy
(RRSO) in germline BRCA1/2 mutation carriers ranges from 4 to 12% but long-term outcomes have not been described.
We evaluated recurrence and survival outcomes of mutation carriers with neoplastic
lesions identified at RRSO.
Methods
We identified BRCA1/2 mutation carriers with neoplasia at RRSO at three institutions. Data was collected
on clinical variables, adjuvant treatment and follow-up.
Results
We identified 32 mutation carriers with invasive carcinomas (n=15) or high-grade intraepithelial neoplasia (n=17) that were not suspected prior to surgery. 26 occurred in BRCA1 and 6 in BRCA2 mutation carriers. Median and mean age for carcinomas were 50 years and 49.3 respectively, significantly younger than for intraepithelial neoplasm,
median 53 years, and mean 55 years (p=0.04). For the 15 invasive carcinomas, median follow up was 88 months (range 45–172 months), 7 recurred (47%), median time to recurrence was 32.5 months and 3 have died of disease; 1 additional patient died of breast cancer. Overall
survival was 73%, disease specific overall survival was 80% and disease free survival
was 66%. For the 17 high-grade intraepithelial neoplasms, median follow up was 80 months (range 40–150), 4 were treated with chemotherapy. One recurred at 43 months and is currently not on therapy with a normal CA125, 16 months later. All patients with noninvasive neoplasia are alive.
Conclusions
BRCA1 and BRCA2 mutation carriers with unsuspected invasive carcinoma at RRSO have a relatively high
rate of recurrence despite predominantly early stage, small volume disease. High-grade
intraepithelial neoplasms rarely recur as carcinoma and may not require adjuvant chemotherapy.
Highlights
- Longterm outcomes of 32 patients with unsuspected noninvasive and invasive neoplasia found at RRSO are reported.
- 47% recurrence rate of the 15 invasive lesions was reported in the median 88mth follow up.
- The first documented case of a recurrence at 43months, after a noninvasive neoplasm in the fallopian tube is reported.
Keywords
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Article info
Publication history
Accepted:
January 29,
2013
Received:
October 9,
2012
Footnotes
☆This work was supported by NIH grants R01CA131965, the Wendy Feuer Ovarian Cancer Research Fund.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
