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Correlation between BRCA mutational status and lymph node metastasis in advanced epithelial ovarian cancer: a
Mingfei Guan1, Xiaojing Wang1, Yinping Ma1
1Department of Gynecological Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
Objective:
To clarify the association between breast cancer (BRCA) mutations and clinically relevant factors, with a particular focus on lymph node metastasis (LNM), in patients with advanced epithelial ovarian cancer (EOC).
Methods:
This retrospective single-center study included patients with histologically confirmed advanced EOC and known BRCA status. Comprehensive clinical, surgical, and pathological data were collected, and survival outcomes were obtained through follow-up. Associations between BRCA mutations and clinicopathological variables were analyzed using univariate and multivariate models. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier analysis and Cox proportional hazards regression.
Results:
A total of 106 patients were included, of whom 34 (32.1%) harbored BRCA mutations. Univariate analysis demonstrated that BRCA-mutated patients had significantly higher rates of abdominopelvic LNM, distant LNM, cardiophrenic LNM, and distant metastasis, as well as more advanced International Federation of Gynecology and Obstetrics (FIGO) stages and higher baseline CA153 levels (≥ 100 U/ml). Multivariate analysis identified abdominopelvic LNM, distant LNM, and baseline CA153 ≥ 100 U/ml as independent correlates of BRCA mutation status (all P < 0.05). Furthermore, for OS, BRCA gene status and achievement of R0 resection were independent prognostic predictors for advanced EOC (both P < 0.05); for PFS, elevated HE4 (≥ 500 U/ml) was identified as an independent adverse prognostic factor (HR = 2.292, 95% CI [1.202-4.371], P = 0.012).
Conclusion:
This study demonstrates that patients with advanced EOC harboring BRCA mutations are more likely to develop both regional and distant LNM. Nevertheless, BRCA mutation status and complete cytoreductive surgery (R0 resection) are associated with favorable prognosis and prolonged survival. Therefore, routine BRCA genetic testing is strongly recommended for all patients with advanced EOC, particularly those presenting with LNM, to facilitate individualized treatment strategies and prognostic assessment.