绝经后会发生什么？（WHAM）：绝经前降低风险的输卵管卵巢切除术后24个月认知的前瞻性对照研究。

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-02-01 DOI:10.1016/j.ygyno.2025.01.008

Pauline M. Maki , Leah H. Rubin , Efrosinia O. Krejany , Alison Brand , Martha Hickey

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引用次数: 0

摘要

目的：BRCA1/2致病性变异的女性考虑行降低风险的双侧卵巢切除术（RRSO）可能会担心手术绝经对认知的潜在影响。RRSO是否影响认知以及激素治疗是否改变这种影响仍不确定。本研究旨在前瞻性地测量绝经前RRSO对认知的影响以及长达24个月的HT的调节作用。方法：设计为前瞻性、多地点（澳大利亚4个地点）、24个月的观察性研究。参与者是绝经前BRCA1/2携带者（n = 83），从妇科肿瘤学和家族性癌症中心转介，计划进行RRSO；绝经前对照组（n = 98），不计划卵巢切除术或怀孕，自行转介。基线数据在8周内收集，RRSO计划在基线至3个月之间进行。在687例筛查中，分析了181例。认知表现（言语学习和记忆、精神运动速度、流畅性）在基线、3、12和24个月时进行评估，其中包括言语学习和记忆的先验结果。结果：在RRSO后，65%的患者开始HT治疗。在认知表现组间差异的多变量模型中，除了语言学习外，RRSO组和对照组表现出相似的表现改善。在对HT和其他因素进行调整后，RRSO组在语言学习方面的改善程度较对照组低，但有统计学意义（p = 0.03）。RRSO后，HT使用者的语言学习水平高于非HT使用者（p = 0.04）。结论和相关性：超过24个月的RRSO对认知的影响最小，除了对语言学习有轻微的不利影响，部分被HT抵消。试验注册：澳大利亚和新西兰临床试验注册中心（anzctr.org.au）；标识符#:ACTRN12615000082505；URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363554&isReview=true。

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What happens after menopause? (WHAM): A prospective controlled study of cognition 24 months after premenopausal risk-reducing salpingo-oophorectomy

Objective

Women with BRCA1/2 pathogenic variants considering risk-reducing bilateral oophorectomy (RRSO) may be concerned about potential effects of surgical menopause on cognition. Whether RRSO affects cognition and whether hormone therapy (HT) modifies this effect remains uncertain. This study aimed to prospectively measure the effect of premenopausal RRSO on cognition and the modifying effects of HT up to 24 months.

Methods

The design was a prospective, multisite (4 sites in Australia), 24-month observational study. Participants were premenopausal BRCA1/2 carriers (n = 83) planning RRSO referred from gynecology-oncology and familial cancer centers and a premenopausal comparison group (n = 98) not planning oophorectomy or pregnancy who self-referred. Baseline data were collected within 8 weeks of eligibility screening, and RRSO was scheduled between baseline and 3 months. Of 687 screened, 181 were analysed. Cognitive performance (verbal learning and memory, psychomotor speed, fluency) was assessed at baseline, 3, 12 and 24 months with the a priori outcomes of verbal learning and memory.

Results

After RRSO, 65 % initiated HT. In multivariable models of group differences in cognitive performance over time, RRSO and comparison groups showed similar performance improvements except for verbal learning. The RRSO group showed a small, statistically significant lower improvement in verbal learning vs comparisons, after adjustment for HT and other factors (p = 0.03). After RRSO, verbal learning was higher in HT users vs non-users (p = 0.04).

Conclusions and relevance

Over 24 months RRSO minimally impacted cognition except for a small adverse effect on verbal learning, partly offset by HT.

Trial registration

Australian and New Zealand Clinical Trials Registry (anzctr.org.au); Identifier #: ACTRN12615000082505; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363554&isReview=true

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy