Findings from a meta-analysis of individual patient data were reported in the Journal of Clinical Oncology. Steenbeek et al found that among women with BRCA1/2 pathogenic variants who underwent risk-reducing salpingo-oophorectomy for prevention of epithelial ovarian cancer, those with serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy were at a greatly increased risk of developing peritoneal carcinomatosis.
As stated by the authors, “After risk-reducing salpingo-oophorectomy, BRCA1/2 pathogenic variant carriers have a residual risk to develop peritoneal carcinomatosis. The etiology of peritoneal carcinomatosis is not yet clarified, but may be related to serous tubal intraepithelial carcinoma, the postulated origin for high-grade serous cancer.”
The study involved unpublished data from cohorts at Kaiser Permanente (San Francisco), MD Anderson Cancer Center, Radboud University Medical Center (Nijmegen) and 15 published studies identified through systematic literature review. The primary outcome measure was the hazard ratio for risk of peritoneal carcinomatosis between BRCA pathogenic variant carriers with and without serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy, and corresponding 5- and 10-year risks.
Key Findings
Individual patient data were available for a total of 3,121 women. Of these, 115 had serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy.
Peritoneal carcinomatosis developed in 15 (13%) of the 115 women with serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy over a median follow-up of 52.5 months (range = 2–246 months) and in 12 (0.4%) of 3,006 women without identified serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy over a median follow-up of 52.5 months (range = 0–281 months). The estimated hazard ratio for developing perineal carcinomatosis during follow-up was 33.9 (95% confidence interval [CI] = 15.6–73.9, P < .001) for women with vs without serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy.
For women with vs without serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy, the predicted 5- and 10-year risks for developing peritoneal carcinomatosis were 10.5% (95% CI = 6.2%–17.2%) vs 0.3% (95% CI = 0.2%–0.6%) and 27.5% (95% CI = 15.6%–43.9%) vs 0.9% (95% CI = 0.6%–1.4%). No cases of peritoneal carcinomatosis occurred within 18 months after risk-reducing salpingo-oophorectomy.
The investigators concluded, “BRCA pathogenic variant carriers with serous tubal intraepithelial carcinoma at risk-reducing salpingo-oophorectomy have a strongly increased risk to develop peritoneal carcinomatosis which increases over time, although current data are limited by small numbers of events.”
Miranda P. Steenbeek, MD, of Radboud University Medical Center, Nijmegen, the Netherlands, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported in part by a grant from the Research Council of Lithuania. For full disclosures of the study authors, visit ascopubs.org.
