Journal
CLINICAL CANCER RESEARCH
Volume 21, Issue 3, Pages 652-657Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1078-0432.CCR-14-2497
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Funding
- Sao Paulo Research Foundation (FAPESP)
- American Cancer Society Early Detection Professorship [SIOP-06-258-01-COUN]
- Asociacion Espanola Contra el Cancer
- Cancer Australia [509303]
- Cancer Council Victoria
- Cancer Council Queensland
- Cancer Council New South Wales
- Cancer Research UK [C490/A10119, C490/A10124, C490/A16561]
- Carlos III Health Institute
- Catalan Health Institute and Autonomous Government of Catalonia [ISCIIIRETIC RD06/0020/105, PI10/01422, PI10/31488, 2009SGR290]
- European Research Council [310018, 2011294576]
- Mermaid Project (Mermaid 1)
- Ministero della Salute of Italy 5 x 1000 fund
- National Breast Cancer Foundation of Australia
- National Cancer Institute [UM1CA164920, R01CA178535, R01CA61107, U01CA71966, R01CA16056, K07CA143047, U01CA69417, P50CA136393, R01CA122443]
- NIHR Biomedical Research Centres at the University of Cambridge
- Royal Marsden NHS Foundation Trust
- Institute of Cancer Research
- National Health and Medical Research Council of Australia [400281, 400413]
- Ovarian Cancer Research Program of the US Department of Defense [W81XWH-08-1-0684, W81XWH-08-10685]
- Peter MacCallum Cancer Centre Foundation
- Scottish Funding Council
- Seventh Framework Programme of the European Union (FP)
- Swedish Cancer Society
- Spanish Health Research Fund
- Swedish Research Council
- University of Sydney Cancer Research Fund
- U.S. Army Medical Research and Materiel Command [DAMD17-01-1-0729]
- Cancer Research UK [11174, 15601, 16561, 16563, 17523] Funding Source: researchfish
- Cancer Research UK
- The Francis Crick Institute [10124] Funding Source: researchfish
- Chief Scientist Office [SCD/11] Funding Source: researchfish
- National Breast Cancer Foundation [IF-12-06] Funding Source: researchfish
- European Research Council (ERC) [310018] Funding Source: European Research Council (ERC)
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Purpose: To analyze the effect of germline mutations in BRCA1 and BRCA2 on mortality in patients with ovarian cancer up to 10 years after diagnosis. Experimental Design: We used unpublished survival time data for 2,242 patients from two case-control studies and extended survival time data for 4,314 patients from previously reported studies. All participants had been screened for deleterious germline mutations in BRCA1 and BRCA2. Survival time was analyzed for the combined data using Cox proportional hazard models with BRCA1 and BRCA2 as time-varying covariates. Competing risks were analyzed using Fine and Gray model. Results: The combined 10-year overall survival rate was 30% [95% confidence interval (CI), 28%-31%] for non-carriers, 25% (95% CI, 22%-28%) for BRCA1 carriers, and 35% (95% CI, 30%-41%) for BRCA2 carriers. The HR for BRCA1 was 0.53 at time zero and increased over time becoming greater than one at 4.8 years. For BRCA2, the HR was 0.42 at time zero and increased over time (predicted to become greater than 1 at 10.5 years). The results were similar when restricted to 3,202 patients with high-grade serous tumors and to ovarian cancer-specific mortality. Conclusions: BRCA1/2 mutations are associated with better short-term survival, but this advantage decreases over time and in BRCA1 carriers is eventually reversed. This may have important implications for therapy of both primary and relapsed disease and for analysis of long-term survival in clinical trials of new agents, particularly those that are effective in BRCA1/ 2 mutation carriers. (C) 2014 AACR.
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