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Stroot IAS, Bart J, Hollema H, Jalving M, Wagner MM, Yigit R, van Doorn HC, de Hullu JA, Gaarenstroom KN, van Beurden M, van Lonkhuijzen LRCW, Slangen BFM, Zweemer RP, Gómez García EB, Ausems MGEM, Boere IA, van Hest LP, Duijkers FAM, van Asperen CJ, Schmidt MK, Wevers MR, Ruijs MWG, Devilee P, Collée JM, Hebon Investigators, de Bock GH, Mourits MJE. Long-term outcome of high-grade serous carcinoma established in risk-reducing salpingo-oophorectomy specimens in asymptomatic BRCA1/2 germline pathogenic variant carriers. Gynecol Oncol 2024; 187:198-203. [PMID: 38795508 DOI: 10.1016/j.ygyno.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The aim of this study was to describe the long-term outcome of asymptomatic BRCA1/2 germline pathogenic variant (GPV) carriers with high-grade serous carcinoma (HGSC) in their risk-reducing salpingo-oophorectomy (RRSO) specimen. METHODS In a previously described cohort of asymptomatic BRCA1/2 GPV carriers derived from the Hereditary Breast and Ovarian cancer in the Netherlands (HEBON) study, women with HGSC at RRSO were identified. Main outcome was ten-year disease-free survival (DFS). Secondary outcomes were time to recurrence, ten-year disease-specific survival (DSS), ten-year overall survival (OS). Patient, disease and treatment characteristics associated with recurrence were described. RESULTS The 28 included women with HGSC at RRSO were diagnosed at a median age of 55.3 years (range: 33.5-74.3). After staging, eighteen women had (FIGO) stage I, three stage II and five had stage III disease. Two women did not undergo surgical staging and were classified as unknown stage. After a median follow-up of 13.5 years (range: 9.1-24.7), six women with stage I (33%), one woman with stage II (33%), two women with stage III (40%) and none of the women with unknown stage developed a recurrence. Median time to recurrence was 6.9 years (range: 0.8-9.2 years). Ten-year DFS was 68%, ten-year DSS was 88% and ten-year OS was 82%. CONCLUSION Most asymptomatic BRCA1/2 GPV carriers with HGSC at RRSO were diagnosed at an early stage. Nevertheless, after a median follow-up of 13.5 years, nine of the 28 women with HGSC at RRSO developed a recurrence after a median of 6.9 years.
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Affiliation(s)
- Iris A S Stroot
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, the Netherlands
| | - Harry Hollema
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, the Netherlands
| | - Mathilde Jalving
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - Marise M Wagner
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| | - Refika Yigit
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
| | - Helena C van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Gynecologic Oncology, Rotterdam, the Netherlands
| | - Joanne A de Hullu
- Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Katja N Gaarenstroom
- Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, the Netherlands
| | - Marc van Beurden
- Antoni van Leeuwenhoek, Department of Gynecology, Amsterdam, the Netherlands
| | - Luc R C W van Lonkhuijzen
- Amsterdam University Medical Center-Center for Gynecological Oncology Amsterdam, Department of Gynecologic Oncology, Amsterdam, the Netherlands
| | - Brigitte F M Slangen
- Maastricht University Medical Center, Department of Gynecology, Maastricht, the Netherlands
| | - Ronald P Zweemer
- University Medical Center Utrecht, Department of Gynecologic Oncology, Utrecht, the Netherlands
| | - Encarna B Gómez García
- University Medical Center Maastricht, Department of Clinical Genetics, Maastricht, the Netherlands
| | - Margreet G E M Ausems
- University Medical Center Utrecht, Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, Utrecht, the Netherlands
| | - Ingrid A Boere
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Liselotte P van Hest
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Human Genetics, Amsterdam, the Netherlands
| | - Floor A M Duijkers
- Amsterdam UMC, University of Amsterdam, Department of Human Genetics, Amsterdam, the Netherlands
| | - Christi J van Asperen
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands
| | - Marjanka K Schmidt
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands; Netherlands Cancer Institute, Department of Epidemiology, Amsterdam, the Netherlands; Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, the Netherlands
| | - Marijke R Wevers
- Radboud University Medical Center, Department of Clinical Genetics, Nijmegen, the Netherlands
| | - Marielle W G Ruijs
- Netherlands Cancer Institute, Department of Clinical Genetics, Amsterdam, the Netherlands
| | - Peter Devilee
- Leiden University Medical Center, Department of Human Genetics & Department of Pathology, Leiden, the Netherlands
| | - J Margriet Collée
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Clinical Genetics, Rotterdam, the Netherlands
| | - Hebon Investigators
- Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON), Coordinating Center: Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Marian J E Mourits
- University of Groningen, University Medical Center Groningen, Department of Gynecologic Oncology, Groningen, the Netherlands
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van den Berg CB, Dasgupta S, Ewing-Graham PC, Bart J, Bulten J, Gaarenstroom KN, de Hullu JA, Mom CH, Mourits MJE, Steenbeek MP, van Marion R, van Beekhuizen HJ. Does serous tubal intraepithelial carcinoma (STIC) metastasize? The clonal relationship between STIC and subsequent high-grade serous carcinoma in BRCA1/2 mutation carriers several years after risk-reducing salpingo-oophorectomy. Gynecol Oncol 2024; 187:113-119. [PMID: 38759517 DOI: 10.1016/j.ygyno.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE The majority of high-grade serous carcinomas (HGSC) of the ovary, fallopian tube, and peritoneum arise from the precursor lesion called serous tubal intraepithelial carcinoma (STIC). It has been postulated that cells from STICs exfoliate into the peritoneal cavity and give rise to peritoneal HGSC several years later. While co-existent STICs and HGSCs have been reported to share similarities in their mutational profiles, clonal relationship between temporally distant STICs and HGSCs have been infrequently studied and the natural history of STICs remains poorly understood. METHODS We performed focused searches in two national databases from the Netherlands and identified a series of BRCA1/2 germline pathogenic variant (GPV) carriers (n = 7) who had STIC, and no detectable invasive carcinoma, at the time of their risk-reducing salpingo-oophorectomy (RRSO), and later developed peritoneal HGSC. The clonal relationship between these STICs and HGSCs was investigated by comparing their genetic mutational profile by performing next-generation targeted sequencing. RESULTS Identical pathogenic mutations and loss of heterozygosity of TP53 were identified in the STICs and HGSCs of five of the seven patients (71%), confirming the clonal relationship of the lesions. Median interval for developing HGSC after RRSO was 59 months (range: 24-118 months). CONCLUSION Our results indicate that cells from STIC can shed into the peritoneal cavity and give rise to HGSC after long lag periods in BRCA1/2 GPV carriers, and argues in favor of the hypothesis that STIC lesions may metastasize.
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Affiliation(s)
- C B van den Berg
- Department of Gynecologic Oncology, Erasmus MC Cancer Center, University Medical Center, Rotterdam, the Netherlands.
| | - S Dasgupta
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Imaging Platform, Broad Institute of MIT and Harvard, Cambridge, United States
| | - P C Ewing-Graham
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J Bart
- Department of Pathology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - J Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K N Gaarenstroom
- Department of Gynecologic Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J A de Hullu
- Department of Gynecologic Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C H Mom
- Department of Gynecologic Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, Center for Gynecologic Oncology Amsterdam, the Netherlands
| | - M J E Mourits
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M P Steenbeek
- Department of Gynecologic Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R van Marion
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - H J van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Center, University Medical Center, Rotterdam, the Netherlands
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Paracchini L, Mannarino L, Romualdi C, Zadro R, Beltrame L, Fuso Nerini I, Zola P, Laudani ME, Pagano E, Giordano L, Fruscio R, Landoni F, Franceschi S, Dalessandro ML, Canzonieri V, Bocciolone L, Lorusso D, Bosetti C, Raspagliesi F, Garassino IMG, D'Incalci M, Marchini S. Genomic instability analysis in DNA from Papanicolaou test provides proof-of-principle early diagnosis of high-grade serous ovarian cancer. Sci Transl Med 2023; 15:eadi2556. [PMID: 38055801 DOI: 10.1126/scitranslmed.adi2556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023]
Abstract
Late diagnosis and the lack of screening methods for early detection define high-grade serous ovarian cancer (HGSOC) as the gynecological malignancy with the highest mortality rate. In the work presented here, we investigated a retrospective and multicentric cohort of 250 archival Papanicolaou (Pap) test smears collected during routine gynecological screening. Samples were taken at different time points (from 1 month to 13.5 years before diagnosis) from 113 presymptomatic women who were subsequently diagnosed with HGSOC (pre-HGSOC) and from 77 healthy women. Genome instability was detected through low-pass whole-genome sequencing of DNA derived from Pap test samples in terms of copy number profile abnormality (CPA). CPA values of DNA extracted from Pap test samples from pre-HGSOC women were substantially higher than those in samples from healthy women. Consistently with the longitudinal analysis of clonal pathogenic TP53 mutations, this assay could detect HGSOC presence up to 9 years before diagnosis. This finding confirms the continual shedding of tumor cells from fimbriae toward the endocervical canal, suggesting a new path for the early diagnosis of HGSOC. We integrated the CPA score into the EVA (early ovarian cancer) test, the sensitivity of which was 75% (95% CI, 64.97 to 85.79), the specificity 96% (95% CI, 88.35 to 100.00), and the accuracy 81%. This proof-of-principle study indicates that the early diagnosis of HGSOC is feasible through the analysis of genomic alterations in DNA from endocervical smears.
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Affiliation(s)
- Lara Paracchini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Laura Mannarino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Chiara Romualdi
- Department of Biology, University of Padua, Padua 35121, Italy
| | - Riccardo Zadro
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Luca Beltrame
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Ilaria Fuso Nerini
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Paolo Zola
- Department of Surgical Science, University of Turin, Turin 10126, Italy
| | - Maria E Laudani
- Department of Surgical Science, University of Turin, Turin 10126, Italy
| | - Eva Pagano
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin 10126, Italy
| | - Livia Giordano
- Unit of Clinical Epidemiology, Città della Salute e della Scienza Hospital, University of Turin and CPO Piemonte, Turin 10126, Italy
| | - Robert Fruscio
- Department of Obstetrics and Gynaecology, Università degli Studi Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynaecology, Università degli Studi Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Silvia Franceschi
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone 33081, Italy
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan 20132, Italy
| | - Maria L Dalessandro
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Vincenzo Canzonieri
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone 33081, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan 20132, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Cristina Bosetti
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan 20133, Italy
| | - Isabella M G Garassino
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Maurizio D'Incalci
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan 20072, Italy
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
| | - Sergio Marchini
- Laboratory of Cancer Pharmacology, IRCCS Humanitas Research Hospital, Rozzano, Milan 20089, Italy
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