abstract
OBJECTIVES:
After
a diagnosis of ovarian cancer, positive BRCA mutation status confers a
transient mortality benefit that diminishes with time. The majority of
women who survive for 10-12years are effectively cured of their disease.
Thus, it is important to estimate the probability of long-term survival
by BRCA mutation status and treatment-related factors.
METHODS:
We
included unselected epithelial ovarian cancers diagnosed in Ontario,
Canada from 1995 to 1999 and from 2002 to 2004. Clinical information was
obtained from medical records. Survival status was determined by
linkage to the Ontario Cancer Registry. We estimated the annual
mortality for these patients.
We compared women who did and did not
survive 10years for a range of factors including BRCA mutation status
and extent of residual disease post-surgery.
RESULTS:
Of
the 1421 patients, 109 (7.7%) had BRCA1 mutations and 68 (4.8%) had
BRCA2 mutations. A status of no residual disease was achieved by 39% of
non-carriers and 19% of mutation carriers (P<0.0001). By 10-years of
follow-up, 43% of non-carriers, 57% of BRCA1 mutation carriers and 69%
of BRCA2 mutation carriers had died from ovarian cancer. Among women
with stage III/IV serous cancers and no residual disease, the 10-year
actuarial survival was 42% for non-carriers and 29% for mutation
carriers (P=0.40).
CONCLUSION:
The
initial survival advantage among women with BRCA mutations may reflect a
higher initial sensitivity of BRCA carriers to chemotherapy, but this
response does not predict long-term survival. The strongest predictor of
long-term survival is status of no residual disease at resection.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.