良性卵巢囊肿与卵巢癌：一项对筛查有启示意义的队列研究。

Benign ovarian cysts and ovarian cancer: a cohort study with implications for screening.

作者信息

Crayford T J, Campbell S, Bourne T H, Rawson H J, Collins W P

机构信息

Department of Epidemiology and Public Health, Guy's, King's, and St Thomas' School of Medicine, King's College Hospital, London, UK.

出版信息

Lancet. 2000 Mar 25;355(9209):1060-3. doi: 10.1016/S0140-6736(00)02038-9.

DOI:10.1016/S0140-6736(00)02038-9

PMID:10744092

Abstract

BACKGROUND

Whether some benign ovarian cysts can develop into cancerous cysts is not known. If a large proportion of ovarian cancers arose in this way, it might be possible to remove the benign cysts in a screening programme before they became malignant. We used follow-up data from a cohort of 5479 self-referred women without symptoms, who participated in a ultrasonographic-screening trial for early ovarian cancer between June, 1981, and August, 1987. We assessed whether the removal of persistent ovarian cysts from these women was associated with a reduction in the expected number of deaths from ovarian cancer in the cohort as a whole.

METHODS

The expected number of deaths from all causes, all cancers, and ovarian, breast, and colorectal cancers were calculated for the study cohort by the standard life-table method. The actual number of deaths and each cause were obtained and the proportional mortality ratio was calculated for each cause of death.

FINDINGS

5135 (95%) of the participants in the original trial were traced. During the screening, five of these women were found to have stage I epithelial ovarian cancer and 88 had benign epithelial ovarian tumours. The number of reported deaths from all causes (387 [50% of expected]), all cancers (221 [71%]), and ovarian cancer (22 [90%]) was lower than expected because of the "healthy-volunteer effect". Proportional mortality ratios were 100% (by definition) for all cancers, 141% for breast cancer, 128% for ovarian cancer (95% CI 87.7-187.6, p=0.19), 84% for colorectal cancer, and 48% for lung cancer.

INTERPRETATION

The removal of persistent ovarian cysts was not associated with a decrease in the proportion of expected deaths from ovarian cancer relative to other cancers during follow-up. For population-based screening of healthy women without a family history of ovarian cancer, a screening test is required that is specific and sensitive to early malignant disease, and inexpensive.

摘要

背景

尚不清楚一些良性卵巢囊肿是否会发展为癌性囊肿。如果很大一部分卵巢癌是以这种方式产生的，那么或许有可能在筛查项目中，在良性囊肿恶变之前将其切除。我们使用了来自5479名无症状的自我推荐女性队列的随访数据，这些女性在1981年6月至1987年8月期间参加了一项早期卵巢癌超声筛查试验。我们评估了从这些女性中切除持续性卵巢囊肿是否与整个队列中卵巢癌预期死亡人数的减少相关。

方法

采用标准生命表法计算研究队列中所有原因、所有癌症以及卵巢癌、乳腺癌和结直肠癌的预期死亡人数。获取实际死亡人数及每种死因的情况，并计算每种死因的比例死亡率。

结果

原始试验中的5135名（95%）参与者被追踪到。在筛查期间，这些女性中有5人被发现患有Ⅰ期上皮性卵巢癌，88人患有良性上皮性卵巢肿瘤。由于“健康志愿者效应”，所有原因（387例[预期的50%]）、所有癌症（221例[71%]）以及卵巢癌（22例[90%]）的报告死亡人数均低于预期。所有癌症的比例死亡率为100%（根据定义），乳腺癌为141%，卵巢癌为128%（95%可信区间87.7 - 187.6，p = 0.19），结直肠癌为84%，肺癌为48%。