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Surgical ovarian suppression for adjuvant treatment in hormone receptor positive breast cancer in premenopausal patients
  1. Anton Oseledchyk1,
  2. Mary L Gemignani2,
  3. Qin C Zhou3,
  4. Alexia Iasonos3,
  5. Rahmi Elahjji4,
  6. Zara Adamou4,
  7. Noah Feit4,
  8. Shari B Goldfarb5,
  9. Kara Long Roche4,
  10. Yukio Sonoda4,
  11. Deborah J Goldfrank4,
  12. Dennis S Chi4,
  13. Sally S Saban4,
  14. Vance Broach4,
  15. Nadeem R Abu-Rustum4,
  16. Jeanne Carter6,
  17. Mario Leitao4 and
  18. Oliver Zivanovic4
  1. 1Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Breast Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  5. 5Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  6. 6Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Oliver Zivanovic, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; zivanovo{at}mskcc.org

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 χ2 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.

  • surgical oncology
  • gynecologic surgical procedures

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Footnotes

  • Twitter @VanceBroach, @leitaomd

  • Contributors AO: concept; design; data interpretation; drafting of manuscript; agrees to be responsible for all aspects of work. MLG: concept; data interpretation; supervision; drafting of manuscript; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. QCZ: data acquisition; drafting of manuscript; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. AI: data acquisition; data interpretation; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. RE: data acquisition; data interpretation; drafting of manuscript; agrees to be responsible for all aspects of work. ZA: data acquisition; data interpretation; drafting of manuscript; agrees to be responsible for all aspects of work. NF: data acquisition; data interpretation; drafting of manuscript; agrees to be responsible for all aspects of work. SBG: data interpretation; drafting of manuscript; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. KL: data interpretation; drafting of manuscript; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. YS: data interpretation; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. DJG: data interpretation; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. DSC: data interpretation; supervision; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. SSS: data acquisition; data interpretation; drafting of manuscript; agrees to be responsible for all aspects of work. VB: data interpretation; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. NRA-R: data interpretation; supervision; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. JC: data interpretation; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. ML: data interpretation; supervision; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work. OZ: concept; design; data interpretation; supervision; drafting of manuscript; review of manuscript for important intellectual content; agrees to be responsible for all aspects of work.

  • Funding This study was funded in part through the NIH/NCI Support Grant P30 CA008748.

  • Disclaimer NAR reports grants from Stryker/Novadaq, grants from Olympus, grants from GRAIL, outside the submitted work. JC reports grants from Fidia grants from Sprout, outside the submitted work. DSC reports personal fees from Bovie Medical Co., personal fees from Verthermia Inc. (now Apyx Medical Corp.), personal fees from C Surgeries, personal fees from Biom 'Up, other from Intuitive Surgical Inc., other from TransEnterix Inc., outside the submitted work. AI reports personal fees from Mylan, outside the submitted work. MML is a consultant for Intuitive Surgical Inc., outside the submitted work. KLR reports other from Intuitive Surgical Inc., outside the submitted work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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