Queensland Centre for Gynaecological Cancer School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Int J Cancer. 2014 May 1;134(9):2211-22. doi: 10.1002/ijc.28537. Epub 2013 Oct 31.
Prophylactic surgery including hysterectomy and bilateral salpingo-oophorectomy (BSO) is recommended in breast cancer susceptibility gene (BRCA)-positive women, whereas in women from the general population, hysterectomy plus BSO may increase the risk of overall mortality. The effect of hysterectomy plus BSO on women previously diagnosed with breast cancer is unknown. We used data from a population-base data linkage study of all women diagnosed with primary breast cancer in Queensland, Australia between 1997 and 2008 (n = 21,067). We fitted flexible parametric breast cancer-specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of risk-reducing surgery (removal of uterus, one or both ovaries). We also stratified analyses by age 20-49 and 50-79 years, respectively. Overall, 1,426 women (7%) underwent risk-reducing surgery (13% of premenopausal women and 3% of postmenopausal women). No women who had risk-reducing surgery compared to 171 who did not have risk-reducing surgery developed a gynaecological cancer. Overall, 3,165 (15%) women died, including 2,195 (10%) from breast cancer. Hysterectomy plus BSO was associated with significantly reduced risk of death overall [adjusted hazard ration (HR), 0.69; 95% confidence interval (CI), 0.53-0.89; p = 0.005]. Risk reduction was greater among premenopausal women, whose risk of death halved (HR, 0.45; 95% CI, 0.25-0.79; p < 0.006). This was largely driven by reduction in breast cancer-specific mortality (HR, 0.43; 95% CI, 0.24-0.79; p < 0.006). This population-based study found that risk-reducing surgery halved the mortality risk for premenopausal breast cancer patients. Replication of our results in independent cohorts and subsequently randomised trials are needed to confirm these findings.
预防性手术（包括子宫切除术和双侧输卵管卵巢切除术）被推荐用于携带乳腺癌易感基因（BRCA）的女性，而对于普通人群中的女性，子宫切除术加双侧输卵管卵巢切除术可能会增加整体死亡率。对于先前被诊断患有乳腺癌的女性，子宫切除术加双侧输卵管卵巢切除术的效果尚不清楚。我们使用了澳大利亚昆士兰州所有在 1997 年至 2008 年间被诊断为原发性乳腺癌的女性的人群基础数据链接研究的数据（n = 21,067）。我们使用灵活的参数乳腺癌特异性和整体生存模型（也称为 Royston-Parmar 模型）来评估降低风险手术（切除子宫、一个或两个卵巢）的影响。我们还分别按年龄 20-49 岁和 50-79 岁进行了分层分析。总体而言，有 1426 名女性（7%）接受了降低风险的手术（13%为绝经前女性，3%为绝经后女性）。与未接受降低风险手术的 171 名女性相比，没有接受降低风险手术的女性患上妇科癌症。总体而言，有 3,165 名（15%）女性死亡，其中 2,195 名（10%）死于乳腺癌。子宫切除术加双侧输卵管卵巢切除术与整体死亡率显著降低相关（调整后的危险比[HR]，0.69；95%置信区间[CI]，0.53-0.89；p = 0.005）。在绝经前女性中，风险降低更为显著，其死亡风险减半（HR，0.45；95%CI，0.25-0.79；p < 0.006）。这主要是由于乳腺癌特异性死亡率的降低（HR，0.43；95%CI，0.24-0.79；p < 0.006）。这项基于人群的研究发现，对于绝经前乳腺癌患者，降低风险的手术使死亡率降低了一半。需要在独立队列和随后的随机试验中复制我们的结果，以确认这些发现。
