Association of BRCA 1 and BRCA 2 Mutational Status on Prognosis of Early-Stage Serous Epithelial Ovarian Cancer

Author(s): Mst. Jakanta Faika, Nahida Yeasmin, Fatema Nihar, Naznine Akter, Syfun Naher, Rowson Ara, Kashfia Binte Quasem, Jannatul Ferdous

Background: The seventh most frequent gynecologic cancer in the world is ovarian cancer. Due to its advanced state at diagnosis, it is the worst gynecological cancer. Despite being a disease found in wealthy nations, its prevalence has been rising daily in underdeveloped nations like Bangladesh. While the majority of ovarian cancer cases are rare, women with BRCA 1 and BRCA 2 mutations, which indicate the hereditary basis of ovarian cancer, have an increased chance of developing epithelial ovarian cancer. Objective: The aim of this study is to assess the prognosis of early-stage serous epithelial ovarian cancer in patients with BRCA 1 and BRCA 2 mutation compared to those without mutation. Methods: The longitudinal cohort study was conducted in the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) & NICRH Dhaka. Study period was from May 2020 to December 2021. A total 32 women with histopathologically confirmed early stage (FIGO stage I to II) serous epithelial ovarian cancer were included in the study. Participants were divided into two groups according to their mutation status; patients with BRCA mutation were Exposed Group and those without BRCA mutation as Unexposed Group. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, maximum study subjects 12(75.0%) were in ≤45 years age group in exposed group and 14(87.5%) were in >45 years age group in unexposed group. Mean age of the study subjects was 37.33±3.55 and 42.43±4.22 years in exposed and unexposed group respectively. Majority of the patients 11 (68.8%) and 12 (75.0%) were literate and 5 (31.3%) and 4 (25.0%) were illiterate in exposed and unexposed group respectively. About 6 (37.5%) respondent of exposed group and 5 (31.3%) of unexposed group had family history of breast / ovarian cancer. majority respondents of Unexposed group 12 (75.0%) underwent Primary Debulking Surgery as primary treatment modality, whereas 9 (56.2%) exposed group did not receive Primary Debulking Surgery. Majority respondents of exposed group 9 (56.2%) received neo adjuvant chemotherapy and interval debulking surgery, whereas 3 (18.8%) respondents of unexposed group received Neoadjuvant chemotherapy and interval debulking surgery. About 2 (12.5%) respondent of Exposed group and 5 (31.3%) of Unexposed group showed recurrence of disease. Though disease recurrence was less in Exposed group. About 2 (12.5%) respondents of Exposed group and 4 (25.0%) of Unexposed group showed platinum sensitive recurrence. Mean time of recurrence for Exposed group and for Unexposed group was 11.34±2.63 and 9.33±3.34 months respectively. Mean progression free survival for Exposed group and for Unexposed group was 13.35±2.24 and 11.18±2.54 months respectively. Mean treatment free interval (TFI) for Exposed group and for Unexposed group was 11.17±2.16 and 9.24±2.07 months respectively. One-year overall survival for Exposed group was more 15 (93.8%) and for Unexposed group was 14 (87.5%). Conclusion: According to these results, BRCA mutation carriers may have a better prognosis than BRCA non-mutation carriers for early-stage serous ovarian cancer, which is typically diagnosed at a younger age and has a positive family history of both breast and ovarian cancer. To validate these findings, larger, multicentric investigations with a larger sample size are required.