title: Outcomes of primary surgical cytoreduction in patients with BRCA-associated high-grade serous ovarian carcinoma.
abstract: OBJECTIVE
  BRCA-associated and sporadic ovarian cancers have different pathologic and clinical features. Our goal was to determine if BRCA mutation status is an independent predictor of residual tumor volume following primary surgical cytoreduction.
  
  
  METHODS
  We conducted a retrospective analysis of patients with FIGO stage IIIC-IV high-grade serous ovarian cancer classified for the presence or absence of germline BRCA mutations. The primary outcome was tumor-debulking status categorized as complete gross resection (0mm), optimal but visible disease (1-10 mm), or suboptimal debulking (>10 mm) following primary surgical cytoreduction. Overall survival by residual tumor size and BRCA status was also assessed as a secondary endpoint.
  
  
  RESULTS
  Data from 367 patients (69 BRCA mutated, 298 BRCA wild-type) were analyzed. Rate of optimal tumor debulking (0-10 mm) in BRCA wild-type and BRCA-mutated patients were 70.1% and 84.1%, respectively (P=0.02). On univariate analysis, increasing age (10-year OR, 1.33; 95% CI, 1.07-1.65; P=0.01) and wild-type BRCA status (OR, 0.47; 95% CI, 0.23-0.94, P=0.03) were both significantly associated with suboptimal surgical outcome. On multivariate analysis, BRCA mutation status was no longer associated with residual tumor volume (OR, 0.63; 95% CI, 0.31-1.29; P=0.21) while age remained a borderline significant predictor (10-year OR, 1.25; 95% CI, 1.01-1.56; P=0.05). Both smaller residual tumor volume and mutant BRCA status were significantly associated with improved overall survival.
  
  
  CONCLUSIONS
  BRCA mutation status is not associated with the rate of optimal tumor debulking at primary surgery after accounting for differences in patient age. Improved survival of BRCA carriers is unlikely the result of better surgical outcomes but instead intrinsic tumor biology.
authors.affiliation: Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY 10065, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Hyman
authors.forename: Kara C
authors.initials: KC
authors.lastname: Long
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Tanner
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Grisham
authors.forename: Angela G
authors.initials: AG
authors.lastname: Arnold
authors.forename: Jasmine
authors.initials: J
authors.lastname: Bhatia
authors.forename: Mary F
authors.initials: MF
authors.lastname: Phillips
authors.forename: David R
authors.initials: DR
authors.lastname: Spriggs
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Noah D
authors.initials: ND
authors.lastname: Kauff
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D018095:Germ-Line Mutation; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome