目的:评估乳腺癌(BC)和卵巢癌(OC)预防降低风险手术(RRS)对生活质量(QoL)的影响。我们考虑降低风险的乳房切除术(RRM),降低风险的输卵管卵巢切除术(RRSO),和降低风险的早期输卵管切除术和延迟卵巢切除术(RRESDO)。
方法:我们遵循了前瞻性方案(PROSPERO:CRD42022319782)并搜索了MEDLINE,EMBASE,PubMed,和Cochrane图书馆从成立到2023年2月。
方法:我们遵循PICOS框架。人群包括BC或OC风险增加的女性。我们专注于报告QoL结果的研究(健康相关QoL(HRQoL),性功能,更年期症状,身体形象,与癌症相关的痛苦或担忧,焦虑或抑郁)RRS后,包括BC的RRM和OC的RRSO或RRESDO。
方法:我们使用非随机研究方法学指数(MINORS)进行研究评估。进行了定性综合和固定效应荟萃分析。
结果:纳入34项研究(RRM:16项研究,RRSO:19项研究,RRESDO:2项研究)。在RRM后的13/15研究(N=986)和RRSO后的10/16研究(N=1617)中,HRQoL没有变化或改善。尽管存在短期赤字(RRM后N=96,RRSO后N=459)。在RRSO后的13/16研究(N=1400)中,性功能(使用性活动问卷)受到影响,性快感下降(-1.21[-1.53,-0.89];N=3070)和性不适增加(1.12[0.93,1.31];N=1400)。绝经前RRSO后的激素替代疗法与性快感增加(1.16[0.17,2.15];N=291)和性不适减少(-1.20[-1.75,-0.65];N=157)相关。在RRM后的4/13研究(N=147)中,性功能受到影响,但在9/13研究中稳定(N=799)。在RRM后的7/13研究(N=605)中,身体图像未受影响,而6/13研究(N=391)报告恶化。在RRSO后的12/13研究(N=1759)中报告了更年期症状增加,癌症治疗的功能评估-内分泌子量表减少(-1.96[-2.81,-1.10];N=1745)。在RRM后的5/5研究(N=365)和RRSO后的8/10研究(N=1223)中,癌症相关的痛苦没有变化或减少。RRESDO(2项研究,N=413)具有更好的性功能和更年期特异性QoL。
结论:RRS可能与QoL结局相关。RRM和RRSO减少癌症相关的痛苦,且不影响HRQoL。妇女和临床医生应该意识到RRM后的身体形象问题,连同性功能障碍和RRSO后的更年期症状。RRESDO可能是减轻RRSO的QoL相关风险的有希望的替代方案。
This study aimed to assess the impact of risk-reducing surgery for breast cancer and ovarian cancer prevention on quality of life. We considered risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, and risk-reducing early salpingectomy and delayed oophorectomy.
We followed a prospective protocol (International Prospective Register of Systematic Reviews: CRD42022319782) and searched MEDLINE, Embase, PubMed, and Cochrane Library from inception to February 2023.
We followed a PICOS (population, intervention, comparison, outcome, and study design) framework. The population included women at increased risk of breast cancer or ovarian cancer. We focused on studies reporting quality of life outcomes (health-related quality of life, sexual function, menopause symptoms, body image, cancer-related distress or worry, anxiety, or depression) after risk-reducing surgery, including risk-reducing mastectomy for breast cancer and risk-reducing salpingo-oophorectomy or risk-reducing early salpingectomy and delayed oophorectomy for ovarian cancer.
We used the Methodological Index for Non-Randomized Studies (MINORS) for study appraisal. Qualitative synthesis and fixed-effects meta-analysis were performed.
A total of 34 studies were included (risk-reducing mastectomy: 16 studies; risk-reducing salpingo-oophorectomy: 19 studies; risk-reducing early salpingectomy and delayed oophorectomy: 2 studies). Health-related quality of life was unchanged or improved in 13 of 15 studies after risk-reducing mastectomy (N=986) and 10 of 16 studies after risk-reducing salpingo-oophorectomy (N=1617), despite short-term deficits (N=96 after risk-reducing mastectomy and N=459 after risk-reducing salpingo-oophorectomy). Sexual function (using the Sexual Activity Questionnaire) was affected in 13 of 16 studies (N=1400) after risk-reducing salpingo-oophorectomy in terms of decreased sexual pleasure (-1.21 [-1.53 to -0.89]; N=3070) and increased sexual discomfort (1.12 [0.93-1.31]; N=1400). Hormone replacement therapy after premenopausal risk-reducing salpingo-oophorectomy was associated with an increase (1.16 [0.17-2.15]; N=291) in sexual pleasure and a decrease (-1.20 [-1.75 to -0.65]; N=157) in sexual discomfort. Sexual function was affected in 4 of 13 studies (N=147) after risk-reducing mastectomy, but stable in 9 of 13 studies (N=799). Body image was unaffected in 7 of 13 studies (N=605) after risk-reducing mastectomy, whereas 6 of 13 studies (N=391) reported worsening. Increased menopause symptoms were reported in 12 of 13 studies (N=1759) after risk-reducing salpingo-oophorectomy with a reduction (-1.96 [-2.81 to -1.10]; N=1745) in the Functional Assessment of Cancer Therapy - Endocrine Symptoms. Cancer-related distress was unchanged or decreased in 5 of 5 studies after risk-reducing mastectomy (N=365) and 8 of 10 studies after risk-reducing salpingo-oophorectomy (N=1223). Risk-reducing early salpingectomy and delayed oophorectomy (2 studies, N=413) led to better sexual function and menopause-specific quality of life.
Risk-reducing surgery may be associated with quality of life outcomes. Risk-reducing mastectomy and risk-reducing salpingo-oophorectomy reduce cancer-related distress, and do not affect health-related quality of life. Women and clinicians should be aware of body image problems after risk-reducing mastectomy, and of sexual dysfunction and menopause symptoms after risk-reducing salpingo-oophorectomy. Risk-reducing early salpingectomy and delayed oophorectomy may be a promising alternative to mitigate quality of life-related risks of risk-reducing salpingo-oophorectomy.