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Germline BRCA mutation carriers are more likely to undergo cytoreductive surgery for relapsed, platinum sensitive, ovarian cancer

  • Author Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Kadan Yfat
    Correspondence
    Corresponding author at: Haemek medical center, Yitshak Rabin Boulevard 21, Afula 1834111, Israel.
    Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Affiliations
    Gynecologic Oncology division, HaEmek MC, Afula, Israel
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  • Kotait Mariam
    Affiliations
    Juravinski Cancer Center, Hamilton Health Sciences and McMaster University, Canada
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  • Author Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Beiner Mario
    Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Affiliations
    Meir Medical Center, Kfar Saba, Israel
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  • Hirte Hal
    Affiliations
    Juravinski Cancer Center, Hamilton Health Sciences and McMaster University, Canada
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  • Author Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Josephy Dana
    Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Affiliations
    Meir Medical Center, Kfar Saba, Israel
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  • Author Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Salman Lina
    Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Affiliations
    Gynecologic Oncology division, Hillel Yaffe Medical Center, Hadera, Israel
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  • Author Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Bruchim Ilan
    Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    Affiliations
    Gynecologic Oncology division, Hillel Yaffe Medical Center, Hadera, Israel
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  • Pond Gregory
    Affiliations
    Juravinski Cancer Center, Hamilton Health Sciences and McMaster University, Canada
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  • Author Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Helpman Limor
    Footnotes
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
    Affiliations
    Juravinski Cancer Center, Hamilton Health Sciences and McMaster University, Canada

    Sheba Medical Center, Ramat Gan, Israel
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  • Author Footnotes
    1 Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology.
    2 Affiliated with Sackler faculty of medicine, Tel Aviv University.
Published:September 22, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.08.020

      Highlights

      • Germline BRCA mutation carriers are more likely to undergo secondary cytoreduction surgery.
      • Longer time to recurrence, non-lymphatic recurrence and no ascites at recurrence were significant predictors of secondary cytoreduction.
      • Oligometastatic disease was the only independent predictor of secondary cytoreduction.

      Abstract

      Objective

      BRCA mutations have been associated with improved outcomes in ovarian cancer patients. This study's objective was to compare the secondary cytoreduction surgery (SCS) rates among ovarian cancer patients by BRCA mutation status.

      Methods

      The study was retrospective and included platinum sensitive recurrent high grade serous ovarian cancer patients from one Canadian center and two Israeli centers from January 1999 to December 2018. Demographic and genetic data, tumor characteristics, patterns of recurrence and surgical and medical treatments were obtained from electronic charts. Patients were grouped according to BRCA mutation status. Logistic regression analyses were used to explore potential prognostic factors of secondary cytoreduction.

      Results

      147 patients were enrolled, including 97 from Canada and 50 from Israel. Forty-seven patients (32%) had a BRCA mutation, including 39 (26.5%) germline mutations and 8 (5.5%) somatic mutations. Thirty-one patients (21.1%) underwent SCS. The rate of SCS was 33.3% among the germline BRCA mutation carriers and 15.7% among patients without germline BRCA mutation (p = 0.026). Predictors of secondary cytoreduction included germline BRCA mutation (OR = 2.5, p = 0.03), time to recurrence (OR = 1.004 per month, p < 0.001), absence of lymphatic recurrence (OR = 3.08, p = 0.013), three or fewer lesions at recurrence (OR = 36.74, p < 0.001) and absence of ascites (OR = 9.1, p = 0.034). After adjusting for the number of lesions at recurrence, no other variable remained a significant predictor.

      Conclusion

      Germline BRCA mutation carriers are more likely to undergo secondary cytoreduction. This may be mediated in part by lower volume disease at recurrence. This observation should be considered when planning surveillance for these patients after first-line treatment.

      Keywords

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