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Peritoneal carcinomatosis after risk‐reducing surgery in BRCA1/2 mutation carriers
Author(s) -
Harmsen Marline G.,
Piek Jurgen M. J.,
Bulten Johan,
Casey Murray J.,
Rebbeck Timothy R.,
Mourits Marian J.,
Greene Mark H.,
Slangen Brigitte F. M.,
van Beurden Marc,
Massuger Leon F. A. G.,
Hoogerbrugge Nicoline,
de Hullu Joanne A.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31211
Subject(s) - medicine , serous fluid , ovarian cancer , serous carcinoma , prophylactic surgery , surgery , brca mutation , cancer
BACKGROUND Risk‐reducing salpingo‐oophorectomy (RRSO) is recommended for BRCA1/2 mutation carriers because of their increased risk of ovarian carcinoma. Despite RRSO, metachronous peritoneal carcinomatosis occasionally is diagnosed. METHODS The literature was searched for BRCA1/2 mutation carriers with peritoneal carcinomatosis after risk‐reducing surgery. The authors were asked for additional data. Clinical and histopathological data were descriptively analyzed. Cases were compared with a single‐institution control cohort. RESULTS Of 36 cases, 86.1% concerned BRCA1 mutation carriers. The median age of the patients was 52 years (range, 30‐71 years) at the time of risk‐reducing surgery and 60 years (range, 37‐75 years) at the time of diagnosis of peritoneal carcinomatosis. The median interval between the 2 events was 54.5 months (range, 11‐292 months). Peritoneal carcinomatosis was mostly high‐grade serous carcinoma. Histopathological details of the RRSO specimens were retrieved in 8 cases; 5 (62.5%) were found to have serous tubal intraepithelial carcinoma and 1 had epithelial atypia. Cases were older ( P = .025) at the time of risk‐reducing surgery and harbored more serous tubal intraepithelial carcinomas ( P <.001) compared with women from the control cohort. CONCLUSIONS Metachronous peritoneal carcinomatosis after risk‐reducing surgery occurs predominantly in BRCA1 mutation carriers, usually within 5 years. Data have suggested that surgery at a younger age lowers the rates of peritoneal carcinomatosis. These data can be used in the gynecologic counseling of BRCA1/2 mutation carriers. RRSO should include complete salpingectomy. Detailed histopathological examination of specimens removed during RRSO is essential. Cancer 2018;124:952‐9 . © 2018 American Cancer Society .