Effectiveness of prophylactic surgeries in BRCA1 or BRCA2 mutation carriers: a meta-analysis and systematic review
A partir d'une revue systématique de la littérature publiée jusqu'en août 2014 (15 études), cette méta-analyse évalue, du point de vue de l'incidence de cancers gynécologiques (sein, ovaire, trompe de Fallope) et de la mortalité toutes causes confondues, l'efficacité de mastectomies ou de salpingo-ovariectomies prophylactiques chez les patientes porteuses d'une mutation BRCA1 ou BRCA2
Purpose : To systematically investigate the effectiveness of prophylactic surgeries (PS) implemented in women carrying BRCA1/2 mutations.
Experimental design : The PubMed database was searched till August 2014 and 15 studies met the inclusion criteria. Fixed- or random-effects models were conducted according to study heterogeneity. We calculated the pooled relative risks (RRs) for cancer risk or mortality along with 95% confidence intervals (CIs).
Results : Prophylactic bilateral salpingo-oophorectomy (PBSO) and bilateral prophylactic mastectomy (BPM) were both associated with a decreased BC risk in BRCA1/2 mutation carriers (RR = 0.552, 95% CI = 0.448-0.682; RR = 0.114, 95% CI = 0.041-0.317, respectively). Similar findings were observed in BRCA1 and BRCA2 mutation carriers separately. Moreover, contralateral prophylactic mastectomy (CPM) significantly decreased contralateral BC incidence in BRCA1/2 mutation carriers (RR = 0.072, 95% CI = 0.035-0.148). Of note, PBSO was associated with significantly lower all-cause mortality in BRCA1/2 mutation carriers without BC (HR = 0.349, 95% CI = 0.190-0.639) and those with BC (HR = 0.432, 95% CI = 0.318-0.588). In addition, all-cause mortality was significantly lower for patients with CPM than those without (HR = 0.512, 95% CI = 0.368-0.714). However, BPM was not significantly associated with reduced all-cause mortality. Data were insufficient to obtain separate estimates of survival benefit with PS in BRCA1 or BRCA2 mutation carriers.
Conclusions : BRCA1/2 mutation carriers who have been treated with PS have a substantially reduced BC incidence and mortality.
Clinical Cancer Research , résumé, 2016