Surgical ovarian suppression for adjuvant treatment in hormone receptor positive breast cancer in premenopausal patients

• Published in: International journal of gynecological cancer Vol. 31; no. 2; p. 222
• Main Authors: Oseledchyk, Anton, Gemignani, Mary L, Zhou, Qin C, Iasonos, Alexia, Elahjji, Rahmi, Adamou, Zara, Feit, Noah, Goldfarb, Shari B, Long Roche, Kara, Sonoda, Yukio, Goldfrank, Deborah J, Chi, Dennis S, Saban, Sally S, Broach, Vance, Abu-Rustum, Nadeem R, Carter, Jeanne, Leitao, Mario, Zivanovic, Oliver
• Format: Journal Article
• Language: English
• Published: England 01-02-2021
• Subjects: Adult; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Chemotherapy, Adjuvant; Databases, Factual; Female; Gonadotropin-Releasing Hormone - administration & dosage; Humans; Middle Aged; Premenopause; Retrospective Studies; Salpingo-oophorectomy - adverse effects; Salpingo-oophorectomy - methods; Salpingo-oophorectomy - statistics & numerical data; gynecologic surgical procedures; surgical oncology
• ISSN: 1525-1438
• DOI: 10.1136/ijgc-2020-001966

Ovarian suppression is recommended to complement endocrine therapy in premenopausal women with breast cancer and high-risk features. It can be achieved by either medical ovarian suppression or therapeutic bilateral salpingo-oophorectomy. Our objective was to evaluate characteristics of patients with stage I-III hormone receptor positive primary breast cancer who underwent bilateral salpingo-oophorectomy at our institution.
Premenopausal women with stage I-III hormone receptor positive primary breast cancer diagnosed between January 2010 and December 2014 were identified from a database. Patients with confirmed
mutations were excluded. Distribution of characteristics between treatment groups was assessed using χ
test and univariate logistic regression. A multivariate model was based on factors significant on univariate analysis.
Of 2740 women identified, 2018 (74%) received endocrine treatment without ovarian ablation, 516 (19%) received endocrine treatment plus ovarian ablation, and 206 (7.5%) did not receive endocrine treatment. Among patients undergoing ovarian ablation 282/516 (55%) received medical ovarian suppression, while 234 (45%) underwent bilateral salpingo-oophorectomy. By univariate logistic analyses, predictors for ovarian ablation were younger age (OR 0.97), histology (other vs ductal: OR 0.23), lymph node involvement (OR 1.89), higher International Federation of Gynecology and Obstetrics (FIGO) stage (stage II vs I: OR 1.48; stage III vs I: OR 2.86), higher grade (grade 3 vs 1: OR 3.41; grade 2 vs 1: OR 2.99), chemotherapy (OR 1.52), and more recent year of diagnosis (2014 vs 2010; OR 1.713). Only year of diagnosis, stage, and human epidermal growth factor receptor 2 (HER-2) treatment remained significant in the multivariate model. Within the cohort undergoing ovarian ablation, older age (OR 1.05) was associated with therapeutic bilateral salpingo-oophorectomy. Of 234 undergoing bilateral salpingo-oophorectomy, 12 (5%) mild to moderate adverse surgical events were recorded.
Bilateral salpingo-oophorectomy is used frequently as an endocrine ablation strategy. Older age was associated with bilateral salpingo-oophorectomy. Perioperative morbidity was acceptable. Evaluation of long-term effects and quality of life associated with endocrine ablation will help guide patient/provider decision-making.