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目的系统评价预防性输卵管-卵巢切除术(risk-reducing salpingo oophorectomy,RRSO)对BRCA1和BRCA2(以下简称BRCA1/2)突变携带者预防卵巢癌发生的作用,从而为临床医生、遗传咨询师和BRCA1/2突变携带女性提供参考依据。方法 2017年3月至2017年4月检索国内外文献数据库,收集RRSO对BRCA1/2突变携带者发生卵巢癌影响的相关研究。共纳入5项研究,9973例(其中行RRSO组5227例,随访组4746例),运用Revman5.3进行Meta分析。结果 RRSO明显降低了BRCA1/2突变携带者发生卵巢癌的风险(HR=0.19,95%CI:0.14~0.26,P<0.00001)。同时,RRSO还降低了BRCA1/2突变携带者的全因病死率(HR=0.32,95%CI:0.27~0.38,P<0.00001)。结论对于携带BRCA1/2突变的女性,在完成生育后,应进行遗传咨询,结合患者意愿及其年龄,考虑是否行RRSO,以降低卵巢癌发病率和全因病死率。
OBJECTIVE: To evaluate the role of risk-reducing salpingo oophorectomy (RRSO) in preventing the development of ovarian carcinomas in BRCA1 and BRCA2 (hereinafter referred to as BRCA1 / 2) mutation carriers, and to provide evidence for clinicians, genetic counselors and BRCA1 / 2 mutation carrying women to provide a reference. Methods From March 2017 to April 2017, we searched domestic and foreign literature databases and collected relevant research on the effect of RRSO on ovarian cancer in BRCA1 / 2 mutation carriers. A total of 5 studies were enrolled, of which 9973 (5227 RRSO and 4746 follow-up groups) were analyzed by Meta-analysis using Revman5.3. Results RRSO significantly reduced the risk of ovarian cancer in patients with BRCA1 / 2 mutation (HR = 0.19, 95% CI: 0.14-0.26, P <0.00001). At the same time, RRSO also reduced all-cause mortality in carriers of BRCA1 / 2 mutations (HR = 0.32, 95% CI: 0.27-0.38, P <0.00001). Conclusions For women with BRCA1 / 2 mutation, genetic counseling should be conducted after completion of childbirth. Combined with the patients’ wishes and their age, women with BRCA1 / 2 mutation should consider whether to perform RRSO to reduce the incidence of ovarian cancer and all-cause mortality.