The reduction of CA 125 serum levels in BRCA 1/2 mutation carriers after risk-reducing salpingo-oophorectomy is only partially associated with surgery: a prospective cohort, other biomarker controlled, study

Abstract

Objectives A significant reduction in CA 125 postoperative serum levels was observed after risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers. In contrast to previous studies, where control groups were absent, we conducted a prospective study including also a screening only group (RSSO refusal) and a group having previously undergone RRSO. Methods Consecutive BRCA1 and BRCA2 mutation carriers, not hysterectomised, >35 years old and with completed childbearing, were recruited. Some women had previously undergone RRSO (previous RRSO group). The others, who had either chosen RRSO (actual RRSO group) or screening only (screening only group), were enrolled (patient-preference trial). A prospective evaluation (basal and 6-month) of CA 125 and CEA (control biomarker) was performed. Results The study consisted of 116 women, 44.8% BRCA1 and 55.2% BRCA2 mutation carriers (n = 25 in the previous RRSO group, n = 29 in the actual RRSO group, n = 62 in the screening only group). For all subjects, we observed a 6-month decrease in CA 125 (−7.8%, P = 0.003), which was significantly linked only to endometriosis history (odds ratio 1.4; 95% confidence interval 1.1–1.8; P = 0.002). Between different groups, we recorded a non-significantly different decrease in CA 125. CEA showed a 6 months significant increase (+15.4%, P < 0.0001), which was similar between groups. Conclusion The decrease in CA 125 in BRCA mutation carriers after RRSO was only partially associated with surgery, depending also on a physiological decline: this is extremely important in their longitudinal monitoring for the prevention of ovarian cancer.

Diagnostic and prognostic role of TFF3, Romo-1, NF-кB and SFRP4 as biomarkers for endometrial and ovarian cancers: a prospective observational translational study

“…In this respect, Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi), initially used only for OC patients with mutations in BRCA1/2, are the most representative example of targeted therapy [26]. In the BRCA mutation carriers, the role of CA125 evaluation has been described in two different settings by Grandi et al: in the first one, the need for an clinical work-up including CA125 dosage, ultrasound and computed tomography (CT) examination for the early detection of OC [7]; in the second one, in BRCA 1/2 mutation carriers undergoing risk-reducing salpingo-oophorectomy, where CA125 level reduction has been found only partially associated with surgery [8]. However, few markers are currently available and used in endometrial and ovarian cancer [27,28].…”

“…Recent discoveries of genetic pathways and tumor biomarkers in different types of cancers have opened new advances for using some of these biomarkers for the diagnosis, prognosis and as targets for emerging therapies. The oncosuppressor genes BRCA1 and 2 are the best-known genes involved in hereditary OC and breast cancer: indeed, they account for 70-80% of hereditary OC cases [7,8]. Nowadays, numerous markers are already employed for the diagnosis and prognosis of OC.…”

The challenging screen detection of ovarian cancer in BRCA mutation carriers adhering to a 6-month follow-up program: results from a 6-years surveillance

“…At our institution, gynecological surveillance of BRCA mutation carriers includes a 6-month evaluation of CA 125, 11 with concomitant clinical gynecological examination and TVUS. Gynecological surveillance starts at 25 years of age.…”

Satisfaction with prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers is very high and little dependent on the participants’ characteristics at surgery: a prospective study

“…T he lifetime risk of ovarian cancer in women with a proven BRCA mutation by the age of 70 years is very high, approximately 40% in BRCA1 mutation carriers and 18% in BRCA2 mutation carriers. 1 Due to the proven ineffectiveness of gynecologic screening for detecting earlystage ovarian/tubal cancers, [2][3][4] BRCA mutation carriers are recommended to undergo a prophylactic risk-reducing salpingo-oophorectomy (RRSO) at some point in their life. According to the National Comprehensive Cancer Network guidelines, RRSO is recommended for BRCA1 mutation carriers between the ages of 35 and 40 years or when childbearing is complete.…”