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Outcome and Management of Serous Tubal Intraepithelial Carcinoma Following Opportunistic Salpingectomy: Systematic Review and Meta-Analysis

Published:September 10, 2022DOI:https://doi.org/10.1016/j.jogc.2022.08.018

      Abstract

      Objective

      Serous ovarian cancer is the most common subtype of epithelial ovarian carcinoma—the most prevalent type of ovarian cancer. High-grade serous ovarian carcinoma (HGSOC) is thought to arise from the distal fallopian tube, with a precursor lesion known as serous tubal intraepithelial carcinoma (STIC). STICs are found in the final pathology of a salpingectomy specimen in 10%–20% of women with a BRCA gene mutation and 1%–7% of women without a mutation. However, there is currently no official guideline and a paucity of data on the management of STICs.

      Data Sources

      We performed a systematic review following PRISMA guidelines. Five databases were searched for relevant studies on STICs.

      Study Selection

      Two independent reviewers performed the abstract and full-text screening and data extraction, with conflicts resolved through discussion with the third reviewer. The risk of bias of each study was assessed using the Newcastle-Ottawa scale.

      Data Extraction and Synthesis

      Fourteen articles were included. Ninety-nine patients who were diagnosed with STIC and subsequently followed for a mean period of 55.5 months were included in this analysis. Eighty-three patients (83.9%) were BRCA mutation carriers. After the diagnosis of isolated STIC, 7 patients (7.3%) received chemotherapy and 25 (26%) underwent surgical staging. Three of the 25 patients were diagnosed with HGSOC based on the staging surgery. Nine patients were later diagnosed with HGSOC during follow-up, with an average duration of follow-up of 58.5 months between the diagnosis of STIC and the diagnosis of HGSOC.

      Conclusion

      Based on our review of the literature, there is a 10.7% risk of having concurrent HGSOC at the time of STIC diagnosis, and the risk of developing a subsequent HGSOC is 14.5%. BRCA mutation status should be determined in cases of isolated STIC, as 83.9% of patients included in this study were found to carry BRCA mutations. We believe it is necessary to further investigate the role of surgical staging following the diagnosis of STIC.

      Résumé

      Objectif

      Le cancer séreux de l’ovaire est le sous-type de carcinome épithélial ovarien le plus fréquent et le type de cancer de l’ovaire le plus répandu. On pense que le cancer séreux de haut grade de l’ovaire (HGSOC) se développe à partir d’une lésion précurseure, soit un carcinome séreux intraépithélial tubaire (STIC), dans la partie distale des trompes de Fallope. Les STIC sont observés à l’examen anatomopathologique final d’une pièce de salpingectomie chez 10 à 20 % des femmes présentant une mutation des gènes BRCA et chez 1 à 7 % des femmes sans mutation. Cependant, les données sont rares et il n’existe actuellement aucune ligne directrice officielle sur la prise en charge des STIC.

      Sources de données

      Nous avons effectué une revue systématique en suivant la stratégie PRISMA. Nous avons consulté 5 bases de données pour trouver des études pertinentes sur les STIC.

      Sélection des études

      Deux évaluateurs indépendants ont analysé les résumés et les articles en version intégrale, puis extrait les données; les désaccords ont été résolus par une discussion avec un troisième évaluateur. Pour chaque étude, le risque de biais a été évalué au moyen de l’échelle de Newcastle-Ottawa.

      Extraction et synthese des données

      Au total, 14 articles ont été retenus. L’analyse inclut 99 patientes qui ont reçu un diagnostic de STIC et qui ont été suivies pendant une période moyenne de 55,5 mois. De ce nombre, 83 patientes (83,9 %) étaient porteuses d’une mutation des gènes BRCA. Après le diagnostic de STIC isolé, 7 patientes (7,3 %) ont reçu des traitements de chimiothérapie et 25 (26 %) ont subi une stadification chirurgicale. Des 25 patientes, 3 ont reçu un diagnostic de HGSOC d’après la stadification, et 9 autres ont reçu un diagnostic de HGSOC plus tard pendant le suivi. Chez ces patientes, l’intervalle moyen entre le diagnostic de STIC et le diagnostic de HGSOC était de 58,5 mois.

      Conclusion

      D’après notre revue de la littérature, il y a un risque de 10,7 % d’avoir un HGSOC concomitant au moment du diagnostic d’un STIC et de 14,5 % de développer un HGSOC par la suite. Il y a lieu de déterminer le statut mutationnel des gènes BRCA dans les cas de STIC isolé, car 83,9 % des patientes incluses dans cette étude se sont révélées être porteuses d’une mutation des gènes BRCA. Nous croyons qu’il est nécessaire d’analyser davantage le rôle de la stadification chirurgicale après le diagnostic de STIC.

      Keywords

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