Ness R B, Cottreau C
R.B. Ness, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
J Natl Cancer Inst. 1999 Sep 1;91(17):1459-67. doi: 10.1093/jnci/91.17.1459.
Ovarian cancer is a commonly fatal disease for which prevention strategies have been limited, in part because of a lack of understanding of the underlying biology. This paper reviews the epidemiologic literature in the English language on risk factors and protective factors for ovarian cancer and proposes a novel hypothesis that a common mechanism underlying this disease is inflammation. Previous hypotheses about the causes of ovarian cancer have attributed risk to an excess number of lifetime ovulations or to elevations in steroid hormones. Inflammation may underlie ovulatory events because an inflammatory reaction is induced during the process of ovulation. Additional risk factors for ovarian cancer, including asbestos and talc exposure, endometriosis (i.e., ectopic implantation of uterine lining tissue), and pelvic inflammatory disease, cannot be directly linked to ovulation or to hormones but do cause local pelvic inflammation. On the other hand, tubal ligation and hysterectomy act as protective factors, perhaps by diminishing the likelihood that the ovarian epithelium will be exposed to environmental initiators of inflammation. Inflammation entails cell damage, oxidative stress, and elevations of cytokines and prostaglandins, all of which may be mutagenic. The possibility that inflammation is a pathophysiologic contributor to the development of ovarian cancer suggests a directed approach to future research
卵巢癌是一种常见的致命疾病，其预防策略一直有限，部分原因是对潜在生物学机制缺乏了解。本文回顾了英文流行病学文献中关于卵巢癌的危险因素和保护因素，并提出了一个新的假说，即该疾病的一个共同潜在机制是炎症。先前关于卵巢癌病因的假说将风险归因于一生中排卵次数过多或类固醇激素水平升高。炎症可能是排卵事件的基础，因为排卵过程中会引发炎症反应。卵巢癌的其他危险因素，包括接触石棉和滑石粉、子宫内膜异位症（即子宫内膜组织的异位植入）和盆腔炎，虽然不能直接与排卵或激素联系起来，但确实会引起局部盆腔炎症。另一方面，输卵管结扎和子宫切除术起到保护作用，可能是通过降低卵巢上皮暴露于环境炎症引发因素的可能性。炎症会导致细胞损伤、氧化应激以及细胞因子和前列腺素水平升高，所有这些都可能具有致突变性。炎症是卵巢癌发生发展的病理生理因素这一可能性为未来的研究指明了方向
