Impact of primary and secondary cytoreduction in BRCA mutated (BRCAm) patients with ovarian/peritoneal/tubal carcinoma

Abstract

<h3>Objectives:</h3> To evaluate the Impact of primary and secondary cytoreduction on survival in patients with <i>BRCA</i> mutated ovarian/peritoneal/tubal carcinoma (<i>BRCA</i>m). <h3>Methods:</h3> We retrospectively reviewed patients with <i>BRCA</i> mutated EOC treated in our health care system to determine effect of primary and secondary surgery. <h3>Results:</h3> 241 patients with germ-line (230) or somatic (11) <i>BRCA</i>m were studied. 191 patients underwent primary surgery (PS) and 50 received neoadjuvant chemotherapy (NEO). 145 of the PS patients had stage III and IV disease while all 50 of the NEO patients had stage III or IV disease. The median survival for stage III/IV patients with PS was 103.9 months vs 53.8 months with NEO, HR 2.47 (1.48,4.12), p<0.001. The 5-year survivals were 78.1% with PS and 43.0% with NEO. Since 7 of the NEO patients did not undergo interval debulking surgery (IDS) an analysis was performed comparing PS patients to NEO and IDS. In this analysis the median survival was 103.9 months vs 53.8 months for PS and NEO and IDS, respectively, HR 2.65 (1.53,4.59) p<0.001. Figure 1: The 5-year survival rate was 78.0% vs 43.1% for PS and NEO and IDS, respectively. When limited to stage IIIC only the median survival was 103.9 months vs 53.8 months for PS and NEO, respectively, HR 3.36 (1.75,6.45) p<0.001. Figure 2: The 5 year survival rate was 78.7% vs 39.1% for PS and NEO, respectively. When limited to stage IV, the median survival was 82.5 vs 46.4 months for PS and NEO, respectively p=0.65. Recurrences were noted in 147 patients, 49 of which underwent secondary cytoreductive surgery (SCS). Median survivals following recurrence were 101.9 months with SCS and 48.8 months for no SCS HR 2.68 (1.61,4.49) p<0.001. Figure 3: 5-year survivals were noted in 66.4% of patients who underwent SCS and 45.0% of patients who did not undergo SCS. <h3>Conclusions:</h3> Patients with stage IIIC <i>BRCA</i>m who underwent primary surgery for bulk tumor removal had significant improvements in survival. Patients with <i>BRCA</i> mutations with recurrent disease who underwent SCS had significant improvements in survival.