Risk-Reducing Salpingectomy Yields Higher QoL for BRCA1/2 Pathogenic Variant Carriers With Gynecologic Cancer

Patients with gynecologic cancer who were carriers for a BRCA1/2 pathogenic variant and received risk-reducing salpingectomy (RRS) experienced improved menopause-related quality of life compared with those who received risk-reducing salpingo-oophorectomy (RRSO), regardless of treatment with hormone replacement therapy, according to findings from a study (NCT02321228) published in JAMA Oncology.

Without hormone replacing therapy (HRT), the observed mean increase from baseline Greene Climacteric Scale (GCS) was 0.7 points 1 year following RRS and 7.7 points after RRSO. Among patients who did not receive hormone therapy, the adjusted mean increase from the baseline score on the GCS was higher in RRSO by 6.7 points (95% CI, 5.0-8.4; P< .001). In regard to menopause-related quality of life (QoL), patients who received RRSO with HRT compared with RRS had a mean adjusted difference of 3.6 points (95% CI, 2.3-4.8; P < .001).

“In this nationwide, multicenter, nonrandomized controlled preference trial, BRCA1/2-PV carriers appeared to have better menopause-related [quality of life] after RRS than after RRSO. Even when HRT was used, a significantly lower menopause related [quality of life] was observed after RRSO. Furthermore, women reported better sexual functioning after RRS compared with RRSO with and without HRT,” the study’s investigators wrote.

A total of 577 women enrolled in the study, 51.5% (n = 297) of whom were carriers for BRCA1-PV, 48.5% (n = 280) carried BRCA2-PV, and 71.6% (n = 413) chose to undergo RRS with delayed risk-reducing oophorectomy (RRO). Prior to surgery, 5 patients retracted consent and 1 died. Of the women who chose RRS (n = 413), 95.4% (n = 394) underwent surgery. Additionally, among those chose RRSO (n = 164), 93.9% (n = 154) underwent surgery, with 23 women still awaiting surgery.

Among patients who underwent RRSO, the modality was occasionally combined with a hysterectomy (n = 5), breast surgery (n = 14), endometrial polyp resection (n = 1), large loop excisions of the cervical transformation zone (n = 2), or cesarean section (n = 1). Those who underwent RRS, occasionally combined the procedure with hysterectomy (n = 1) or breast surgery (n = 4).

Between both groups that received HRT, the only difference in health-related QoL was a significantly greater decrease in the physical component summary score of the 36-item Short Form Health Survey subscales 3 months after RRSO with HRT compared with RRS.

Those who received RRSO without hormone replacement therapy experienced a mean decrease of 5.1 points at 1 year on the Female Sexual Function Index, compared with those who received RRS and experienced an increase of 0.3 points. After 1 year, women who used HRT following RRSO experienced a significant difference of -2.0 points after 1 year (95% CI, -3.8 to -0.2; P = .03).

Additionally, investigators identified that 35.8% (n = 53) of women at baseline in the RRSO group had impaired sexual functioning based on the validation cutoff point of 26.55 points. However, over 3 months, sexual functioning increased (44.2%; n = 61), as well as increasing over the course of 1 year (55.6%; n = 65). A total of 31.2% of patients in the RRS group (n = 121) had impaired sexual functioning; at 3 months, the rate was 27.6% (n = 103) and at 1 year, investigators reported a rate of 28.2% (n = 85).

For patients who received RRS, the median surgical time was 44 minutes (range, 16-459), and for RRSO it was 57 minutes (range, 24-310). Perioperative complications occurred in 3.3% of women in both groups that were definitely or probably related to the study.

During follow-up, no cases of ovarian or peritoneal cancer were reported, although 8 patients developed breast cancer during follow up and 2 experienced breast cancer recurrence (P = .57).

A total of 14 women underwent RRO at a later stage, and 3 women who were BRCA2-PV carriers underwent RRO within 2 years. Another 3 underwent RRO at 28 months, 53 months, and 54 months following RRS. Eight patients with BRCA1-PV underwent RRO 29 to 61 months after RRS.

Reference

Steenbeek MP, Harmsen MG, Hoogerbrugge N, et al. Association of salpingectomy with delayed oophorectomy versus salpingo-oophorectomy with quality of life in BRCA1/2 pathogenic variant carriers: a nonrandomized controlled trial. JAMA Oncol. 2021;7(8):1203-1212. doi:10.1001/jamaoncol.2021.1590