Pathology results of risk-reducing salpingo-oophorectomy in BRCA1/2 carriers and long-term clinical outcomes.

Abstract

Introduction: BRCA1/2 mutation carriers have a lifetime ovarian cancer risk of 40%-45% for BRCA1 and 15%-20% for BRCA2. The most effective risk-reduction strategy for women with known BRCA mutations remains bilateral risk-reducing salpingo-oophorectomy (RRSO), which reduces the risk by 80%. The primary objective of this study is to assess the long-term incidence of primary peritoneal carcinoma (PPC) following RRSO and to evaluate the occurrence of premalignant and malignant lesions.

Methods: This retrospective cohort study followed BRCA1/2-positive patients who underwent RRSO, using data from two medical centers in Haifa Israel between 2002 and 2023. Data collected included demographic characteristics and pathology results post-surgery. Outcomes included rates of occult cancer (OC), serous tubal intraepithelial carcinoma (STIC), and PPC.

Results: A total of 214 women underwent RRSO. Of these, 126 (58.8%) had a BRCA1 mutation, 76 (35.5%) had a BRCA2 mutation, and 12 (5.6%) carried both BRCA1 and BRCA2 mutations. During a mean follow-up of 122.4 months (SD ± 84.0), three patients (1.5%) developed PPC. OC was identified in 13 patients (6.1%) during RRSO. Out of the 13 OC patients, eight (61.5%) were classified as stage 1. The overall survival for the OC population was 117.2 ± 55.9 months. STIC was detected in two patients.

Conclusion: In this large retrospective analysis of BRCA carriers who underwent RRSO, we confirmed that long-term follow-up is crucial for BRCA mutation carriers undergoing RRSO, as malignancies can still arise over time. In our study, the incidence of PPC was 1.5%, highlighting the need for extended surveillance. These findings underscore the importance of meticulous surgical protocols, expert pathology review, and ongoing monitoring to optimize patient outcomes.