Surgical ovarian suppression for adjuvant treatment in hormone receptor positive breast cancer in premenopausal patients. Issue 2 (3rd December 2020)

• Record Type: Journal Article
• Authors: Oseledchyk, Anton; Gemignani, Mary L; Zhou, Qin C; Iasonos, Alexia; Elahjji, Rahmi; Adamou, Zara; Feit, Noah; Goldfarb, Shari B; Long Roche, Kara; Sonoda, Yukio; Goldfrank, Deborah J; Chi, Dennis S; Saban, Sally S; Broach, Vance; Abu-Rustum, Nadeem R; Carter, Jeanne; Leitao, Mario; Zivanovic, Oliver
• Is Part Of: International journal of gynecological cancer. Volume 31:Issue 2(2021)
• Page Start: 222
• Page End: 231
• Publication Date: 2020-12-03
• Subjects: surgical oncology -- gynecologic surgical procedures; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2020-001966
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objective: Ovarian suppression is recommended to complement endocrine therapy in premenopausal women with breast cancer and high-risk features. It can be achieved by either medical ovarian suppression or therapeutic bilateral salpingo-oophorectomy. Our objective was to evaluate characteristics of patients with stage I–III hormone receptor positive primary breast cancer who underwent bilateral salpingo-oophorectomy at our institution. Materials and methods: Premenopausal women with stage I–III hormone receptor positive primary breast cancer diagnosed between January 2010 and December 2014 were identified from a database. Patients with confirmed BRCA1/2 mutations were excluded. Distribution of characteristics between treatment groups was assessed using χ 2 test and univariate logistic regression. A multivariate model was based on factors significant on univariate analysis. Results: Of 2740 women identified, 2018 (74%) received endocrine treatment without ovarian ablation, 516 (19%) received endocrine treatment plus ovarian ablation, and 206 (7.5%) did not receive endocrine treatment. Among patients undergoing ovarian ablation 282/516 (55%) received medical ovarian suppression, while 234 (45%) underwent bilateral salpingo-oophorectomy. By univariate logistic analyses, predictors for ovarian ablation were younger age (OR 0.97), histology (other vs ductal: OR 0.23), lymph node involvement (OR 1.89), higher International Federation of Gynecology and Obstetrics (FIGO) stage (stage II vs I: OR 1.48; stage III vs I: OR 2.86), higher grade (grade 3 vs 1: OR 3.41; grade 2 vs 1: OR 2.99), chemotherapy (OR 1.52), and more recent year of diagnosis (2014 vs 2010; OR 1.713). Only year of diagnosis, stage, and human epidermal growth factor receptor 2 (HER-2) treatment remained significant in the multivariate model. Within the cohort undergoing ovarian ablation, older age (OR 1.05) was associated with therapeutic bilateral salpingo-oophorectomy. Of 234 undergoing bilateral salpingo-oophorectomy, 12 (5%) mild to moderate adverse surgical events were recorded. Conclusions: Bilateral salpingo-oophorectomy is used frequently as an endocrine ablation strategy. Older age was associated with bilateral salpingo-oophorectomy. Perioperative morbidity was acceptable. Evaluation of long-term effects and quality of life associated with endocrine ablation will help guide patient/provider decision-making.