Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Int J Cancer. 2013 Nov 15;133(10):2415-21. doi: 10.1002/ijc.28249. Epub 2013 Jul 9.
Previous studies have observed that tubal ligation and hysterectomy are associated with a decreased risk of ovarian cancer; however, little is known about whether these associations vary by surgical characteristics, individual characteristics or tumor histology. We used logistic regression to examine tubal ligation, simple hysterectomy and hysterectomy with unilateral oophorectomy in relation to risk of epithelial ovarian cancer in the New England Case-Control Study. Our primary analysis included 2,265 cases and 2,333 controls. Overall, tubal ligation was associated with a lower risk of epithelial ovarian cancer [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.68-0.97], especially for endometrioid tumors (OR = 0.45, 95% CI: 0.29-0.69). The inverse association between tubal ligation and ovarian cancer risk was stronger for women who had undergone the procedure at the time of last delivery (OR = 0.60, 95% CI: 0.42-0.84) rather than at a later time (OR = 0.93, 95% CI: 0.75-1.15). Overall, simple hysterectomy was not associated with ovarian cancer risk (OR: 1.09, 95% CI: 0.83-1.42), although it was associated with a nonsignificant decreased risk of ovarian cancer among women who underwent the procedure at age 45 or older (RR: 0.64, 95% CI: 0.40-1.02) or within the last 10 years (OR = 0.65, 95% CI: 0.38-1.13). Overall, women who had a hysterectomy with a unilateral oophorectomy had significantly lower risk of ovarian cancer (OR = 0.65, 95% CI: 0.45-0.94). In summary, tubal ligation and hysterectomy with unilateral oophorectomy were inversely associated with ovarian cancer risk in a large population-based case-control study. Additional research is necessary to understand the potential biologic mechanisms by which these procedures may reduce ovarian cancer risk.
先前的研究表明，输卵管结扎术和子宫切除术与卵巢癌风险降低有关；然而，对于这些关联是否因手术特征、个体特征或肿瘤组织学而异，人们知之甚少。我们使用逻辑回归分析了新英格兰病例对照研究中输卵管结扎术、单纯子宫切除术和单侧卵巢切除术与上皮性卵巢癌风险的关系。我们的主要分析包括 2265 例病例和 2333 例对照。总体而言，输卵管结扎术与上皮性卵巢癌风险降低相关[比值比（OR）=0.82，95%置信区间（CI）：0.68-0.97]，尤其是子宫内膜样肿瘤（OR=0.45，95%CI：0.29-0.69）。对于最后一次分娩时接受该手术的女性，输卵管结扎术与卵巢癌风险之间的反比关系更强（OR=0.60，95%CI：0.42-0.84），而不是在稍后时间接受手术的女性（OR=0.93，95%CI：0.75-1.15）。总体而言，单纯子宫切除术与卵巢癌风险无关（OR：1.09，95%CI：0.83-1.42），尽管它与 45 岁或以上或最近 10 年内接受手术的女性的卵巢癌风险呈非显著降低相关（RR：0.64，95%CI：0.40-1.02）或（OR=0.65，95%CI：0.38-1.13）。总体而言，单侧卵巢切除术的子宫切除术女性患卵巢癌的风险显著降低（OR=0.65，95%CI：0.45-0.94）。总之，在一项大型基于人群的病例对照研究中，输卵管结扎术和单侧卵巢切除术与卵巢癌风险呈负相关。需要进一步的研究来了解这些手术降低卵巢癌风险的潜在生物学机制。
