O030/#339 Primary cytoreductive surgery leads to improved survival in patients with advanced ovarian cancer with brca germline or somatic mutation. (4th December 2022)

• Record Type: Journal Article
• Authors: Kim, Soyoun Rachel; Piedimonte, Sabrina; Parbhakar, Ashna; Li, Xuan; Bernardini, Marcus; Hogen, Liat; May, Taymaa
• Is Part Of: International journal of gynecological cancer. Volume 32(2022)Supplement 3
• Page Start: A19
• Page End: A19
• Publication Date: 2022-12-04
• Subjects: Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2022-igcs.32
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: Given the platinum sensitivity of BRCA 1/2-mutated high-grade serous ovarian cancers (HGSC), there is uncertainty about the relative benefits of primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy (NACT) in this population. We aimed to compare the long-term survival outcomes for women with germline or somatic BRCA mutations with HGSC undergoing either PCS or NACT. Methods: We conducted a retrospective cohort study of BRCA-associated HGSCs treated with PCS or NACT at a tertiary cancer center between 1991–2020. All patients had confirmed germline or somatic BRCA mutations. Demographics, disease burden, surgical complexity and ten-year overall survival (OS)/recurrence free survival (RFS) were examined. Results: Of 361 women with germline/somatic BRCA mutations, 240 (66%) underwent PCS and 121 (34%) underwent NACT followed by interval cytoreduction (IDS). Those undergoing PCS were younger (54 vs. 57; p<0.001), but there were no differences in functional status or underlying comorbidities. Initial disease burden was lower in PCS cohort, but surgical complexity was higher. The rate of complete cytoreduction was similar in both groups (22% vs 31%; p=0.120) as well as the rate of Poly (ADP-ribose) polymerase (PARP) inhibitor use (35% vs 32%; p=0.68). The 10-year OS and RFS were superior in PCS cohort (OS 54% vs 25%; p<0.001 and RFS 30% vs 10%; p<0.001). After controlling for CA-125 level, stage, length of cytoreduction, disease burden and surgical complexity, PCS remained as a significant predictor of improved OS (HR 0.46; p=0.002) and RFS (HR 0.56; p=0.004). Conclusions: PCS leads to superior survival outcomes compared to NACT in women with BRCA-associated HGSC.