Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Cancer Treat Rev. 2018 Sep;69:66-71. doi: 10.1016/j.ctrv.2018.06.004. Epub 2018 Jun 11.
Ovarian cancer remains the leading cause of gynecologic cancer death among American women. Prevention is the only proven approach to reduce the incidence of the disease. Oral contraception, tubal ligation, and risk-reducing salpingo-oophorectomy (rrBSO) for high-risk groups are all established risk reduction strategies. This paradigm is changing as recent biologic studies suggest that many ovarian cancers, especially high-grade serous ovarian cancers, originate in the distal end of the fallopian tube rather than the ovarian surface epithelium. A putative precursor lesion has been identified called the serous tubal intraepithelial carcinoma (STIC). Theoretically, removal of the fallopian tubes alone may prevent these lesions and prevent overt disease. Opportunistic salpingectomy during benign gynecologic surgery appears to be safe and may offer some protection from ovarian cancer without compromising ovarian endocrine function. Despite a lack of evidence for efficacy, several professional societies now recommend this approach for average-risk women. Whether salpingectomy can also serve as a temporizing measure to delay risk-reducing oophorectomy in women with a genetic predisposition to ovarian cancer remains to be seen. Several ongoing non-randomized clinical trials will test the feasibility of this approach. Therefore, the societal impact of increasing salpingectomy rates on ovarian cancer incidence will be an area of intense focus for the next 10-20 years.
卵巢癌仍然是美国女性妇科癌症死亡的主要原因。预防是降低疾病发病率的唯一有效方法。口服避孕药、输卵管结扎和针对高危人群的降低风险的输卵管卵巢切除术（rrBSO）都是已确立的降低风险策略。这种模式正在发生变化，因为最近的生物学研究表明，许多卵巢癌，特别是高级别浆液性卵巢癌，起源于输卵管的远端，而不是卵巢表面上皮。已经确定了一种称为输卵管上皮内癌（STIC）的假定前体病变。从理论上讲，仅切除输卵管可能会预防这些病变并预防显性疾病。在良性妇科手术中进行机会性输卵管切除术似乎是安全的，并且可以提供一些预防卵巢癌的保护，而不会损害卵巢内分泌功能。尽管缺乏疗效证据，但现在有几个专业协会建议将这种方法用于一般风险的女性。输卵管切除术是否也可以作为一种权宜之计，以延迟具有卵巢癌遗传易感性的女性的降低风险卵巢切除术，还有待观察。几项正在进行的非随机临床试验将测试这种方法的可行性。因此，未来 10-20 年内，增加输卵管切除术率对卵巢癌发病率的社会影响将是一个重点关注领域。
