Department of Medical Epidemiology and Biostatistics (HF, LY, HG, DA) and Department of Women's and Children's Health (HF), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (DA).
J Natl Cancer Inst. 2015 Jan 27;107(2). doi: 10.1093/jnci/dju410. Print 2015 Feb.
Recent genetic and morphologic studies have challenged the traditional view on the pathogenesis of ovarian cancer; suggesting that ovarian cancer predominantly arises within the fallopian tubes or the uterus. We hypothesize that surgical removal of the fallopian tubes is associated with a reduced risk for ovarian cancer.
In this population-based cohort study, we used data on women with previous surgery on benign indication (sterilization, salpingectomy, hysterectomy, and bilateral salpingo-oophorectomy [BSO], hysterectomy; n = 251465) compared with the unexposed population (n = 5449119) between 1973 and 2009 and analyzed with Cox regression models. The effects of one- and two-sided salpingectomy were considered in a subanalysis. All statistical tests were two-sided.
There was a statistically significantly lower risk for ovarian cancer among women with previous salpingectomy (HR = 0.65, 95% CI = 0.52 to 0.81) when compared with the unexposed population. In addition, statistically significant risk reductions were observed among women with previous hysterectomy (HR = 0.79, 95% CI = 0.70 to 0.88), sterilization (HR = 0.72, 95% CI = 0.64 to 0.81), and hysterectomy with BSO (HR = 0.06, 95% CI = 0.03 to 0.12). Bilateral salpingectomy was associated with a 50% decrease in risk of ovarian cancer compared with the unilateral procedure (HR = 0.35, 95% CI = 0.17 to 0.73, and 0.71, 95% CI = 0.56 to 0.91, respectively).
Salpingectomy on benign indication is associated with reduced risk of ovarian cancer. These data support the hypothesis that a substantial fraction of ovarian cancer arises in the fallopian tube. Our results suggest that removal of the fallopian tubes by itself, or concomitantly with other benign surgery, is an effective measure to reduce ovarian cancer risk in the general population.
最近的遗传和形态学研究对卵巢癌的发病机制提出了挑战传统观点；表明卵巢癌主要发生在输卵管或子宫内。我们假设切除输卵管与降低卵巢癌风险有关。
在这项基于人群的队列研究中，我们使用了 1973 年至 2009 年期间因良性指征（绝育、输卵管切除术、子宫切除术和双侧输卵管卵巢切除术[BSO]、子宫切除术）接受手术的女性（n=251465）与未暴露人群（n=5449119）的数据，并通过 Cox 回归模型进行分析。子分析中考虑了单侧和双侧输卵管切除术的影响。所有统计检验均为双侧。
与未暴露人群相比，有输卵管切除术史的女性患卵巢癌的风险显著降低（HR=0.65，95%CI=0.52-0.81）。此外，有子宫切除术史（HR=0.79，95%CI=0.70-0.88）、绝育史（HR=0.72，95%CI=0.64-0.81）和子宫切除术+BSO 史（HR=0.06，95%CI=0.03-0.12）的女性风险也显著降低。与单侧手术相比，双侧输卵管切除术可使卵巢癌风险降低 50%（HR=0.35，95%CI=0.17-0.73 和 0.71，95%CI=0.56-0.91）。
良性指征的输卵管切除术与卵巢癌风险降低有关。这些数据支持这样一种假设，即相当一部分卵巢癌起源于输卵管。我们的结果表明，切除输卵管本身或同时进行其他良性手术，是降低普通人群卵巢癌风险的有效措施。
