title: Improved survival in women with BRCA-associated ovarian carcinoma.
abstract: BACKGROUND
  The objective of this study was to determine the clinical characteristics, treatment response, and frequency of p53 overexpression in Ashkenazi Jewish women with hereditary ovarian carcinoma.
  
  
  METHODS
  Seventy-one Jewish women with epithelial ovarian carcinoma (EOC) were tested for the three BRCA founder mutations using single-strand conformation polymorphism analysis, heteroduplex analysis, and protein truncation testing. Clinical and histopathologic data were reviewed retrospectively. In vitro chemoresistance was analyzed in 32 patients. Mutations of p53 were studied using immunohistochemical detection of p53 overexpression.
  
  
  RESULTS
  Thirty-four of 71 Jewish patients with EOC (48%) had germline BRCA mutations (BRCA heterozygotes), including 22 BRCA1 mutations and 12 BRCA2 mutations. BRCA heterozygotes were younger compared with Jewish patients who had EOC without mutations (sporadic carcinoma; 50 years vs. 59 years, respectively; P = 0.01). BRCA1 heterozygotes were younger compared with BRCA2 heterozygotes (48 years vs. 57 years, respectively; P = 0.01). Histopathologic tumor features were similar; however, tumors with low malignant potential were seen only in women with sporadic carcinoma. Both groups had equivalent rates of surgical cytoreduction and similar median follow-up (72 months). BRCA heterozygotes had higher response rates to primary therapy compared with patients who had sporadic disease (P = 0.01). In vitro chemoresistance predicted tumor response to platinum chemotherapy correctly in BRCA heterozygotes (P = 0.0096). BRCA heterozygotes with advance-stage disease had improved survival compared with patients who had advanced stage sporadic carcinoma (91 months vs. 54 months, respectively; P = 0.046) and had a longer disease free interval (49 months vs. 19 months, respectively; P = 0.16). p53 overexpression was common in BRCA heterozygotes (80%).
  
  
  CONCLUSIONS
  BRCA1 heterozygotes developed EOC at a younger age compared with BRCA2 heterozygotes and women who had sporadic ovarian carcinoma. BRCA heterozygotes had a better response to platinum chemotherapy compared with women who had sporadic disease, which may have contributed to their improved prognosis.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center and University of California-Los Angeles School of Medicine, Los Angeles, California 90048, USAA. cassi@cshs.org
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
authors.forename: Rae Lynn
authors.initials: RL
authors.lastname: Baldwin
authors.forename: Taz
authors.initials: T
authors.lastname: Varkey
authors.forename: Roxana
authors.initials: R
authors.lastname: Moslehi
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D004252:DNA Mutational Analysis; D018572:Disease-Free Survival; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D016158:Genes, p53; D005838:Genotype; D006801:Humans; D007585:Jews / Q000235:genetics; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000208:ethnology / Q000235:genetics* / Q000401:mortality*; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents