Highlights
- •A majority of OOC tumors are diagnosed at an early stage and have PFS and DSS consistent with what would be expected.
- •Women with an OOC diagnosed at the time of RRSO should be managed per stage-appropriate guidelines.
- •The OOC cohort was significantly older at RRSO, with a median age beyond that recommended for risk-reducing surgery.
Abstract
Objective
Prior data suggested that women with incidentally detected occult invasive ovarian
cancer (OIOC) at the time of risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation may have poorer prognoses than would be expected based on disease stage.
We sought to evaluate prevalence and outcomes of patients with OIOC in a tertiary
referral center.
Methods
Patients with BRCA mutation undergoing RRSO from 01/2005 to 05/2017 were identified, and their records
reviewed. Women with incidentally detected OIOC were included; those with clinical
features raising preoperative suspicion for malignancy were excluded.
Results
548 patients with BRCA mutation who underwent RRSO were identified. 26 (4.7%) had an OIOC (median age 55 years;
range 42–75); 15(58%) patients, BRCA1; 9(34%), BRCA2; 2(8%) had a mutation in both genes. All OIOCs were high-grade serous: 10 (38%) Stage
I; 8 (31%) Stage II; 8(31%) Stage III. 24(92%) patients received adjuvant platinum/taxane
therapy. Of Stage III patients, 4 (50%) were identified intraoperatively; the remaining
4 (50%) had microscopic nodal disease on final pathology only. At median follow-up
of 67.3 months (28–166) no Stage I patients have recurred; 2 Stage II and 6 Stage
III patients recurred. 5-year progression-free survival (PFS) was 72% (95%CI, 50.2–85.7%);
median PFS for the cohort was 129 months (95%CI, 75.3-not estimable). 5-year disease-specific
survival (DSS) was 96% (95%CI, 76–99%); median DSS not reached.
Conclusion
Consistent with prior reports, almost 5% of patients had an OIOC at RRSO. The majority
with early-stage disease had excellent PFS and DSS outcomes, as would be expected
based on disease stage.
Keywords
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Article info
Publication history
Published online: March 09, 2021
Accepted:
February 3,
2021
Received:
October 29,
2020
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
