The Queensland Institute of Medical Research, Gynaecological Cancer Group, Population Health Department, PO Royal Brisbane Hospital, Brisbane 4029, Australia.
Eur J Cancer. 2013 Nov;49(17):3638-47. doi: 10.1016/j.ejca.2013.07.005. Epub 2013 Jul 25.
Until recently most studies suggested that hysterectomy with ovarian conservation was associated with a decreased risk of ovarian cancer. However, several recent studies have reported modestly increased risks of ovarian cancer following hysterectomy. Given that as many as 35% of women will have a hysterectomy, the nature of the association requires clarification. We conducted a systematic review and meta-analysis of the published literature on the relationship between hysterectomy and ovarian cancer to investigate whether there has been a temporal change in the association. Twenty observational studies that have reported a quantitative assessment of the association between hysterectomy and risk of histologically-confirmed ovarian cancer were included in the meta-analysis. The overall relative risk (RR) estimate was 0.81 (95% confidence interval (CI) 0.72-0.92) suggesting hysterectomy decreases the risk of ovarian cancer. However, there was significant heterogeneity in the results (I(2) = 74%). Our exploration of sources of heterogeneity and metaregression showed that median year of cancer diagnosis of included cases explained most of the heterogeneity relative risk (RR = 0.70 (95% CI 0.65-0.76) for median year diagnosis pre 2000; RR = 1.18 (95% CI 1.06-1.31) for post 2000). This study shows that there has been a temporal shift in the association between hysterectomy and risk of ovarian cancer. One explanation may be the trend away from hysterectomy in younger women. Other speculative possibilities include the decline in oophorectomy rates and the use of oestrogen-only hormone replacement therapy in hysterectomised women. Until further evidence becomes available, clinicians should not advise women that a hysterectomy without salpingo-oophorectomy will favourably influence their future risk of ovarian cancer.
直到最近，大多数研究表明，保留卵巢的子宫切除术与降低卵巢癌风险相关。然而，最近的几项研究报告称，子宫切除术后卵巢癌的风险略有增加。由于多达 35%的女性将接受子宫切除术，因此需要澄清这种关联的性质。我们对已发表的关于子宫切除术与卵巢癌之间关系的文献进行了系统回顾和荟萃分析，以调查这种关联是否存在时间变化。共有 20 项观察性研究报告了子宫切除术与组织学证实的卵巢癌风险之间的定量评估，这些研究被纳入荟萃分析。总体相对风险（RR）估计值为 0.81（95%置信区间[CI]0.72-0.92），表明子宫切除术降低了卵巢癌的风险。然而，结果存在显著的异质性（I(2)=74%）。我们对异质性来源和荟萃回归的探索表明，纳入病例的癌症诊断中位年份解释了大部分相对风险（RR=0.70（95%CI0.65-0.76），用于 2000 年前的诊断中位年份；RR=1.18（95%CI1.06-1.31），用于 2000 年后的诊断中位年份）。本研究表明，子宫切除术与卵巢癌风险之间的关联存在时间上的变化。一种解释可能是年轻女性中子宫切除术的趋势。其他推测的可能性包括卵巢切除术率下降和子宫切除术后仅使用雌激素激素替代疗法。在进一步的证据出现之前，临床医生不应该建议女性不进行卵巢输卵管切除术的子宫切除术会有利地影响她们未来的卵巢癌风险。
