J Natl Cancer Inst. 2019 Oct 1;111(10):1097-1103. doi: 10.1093/jnci/djz015.
Recent studies have called into question the long-held belief that hysterectomy without oophorectomy protects against ovarian cancer. This population-based longitudinal record-linkage study aimed to explore this relationship, overall and by age at hysterectomy, time period, surgery type, and indication for hysterectomy.
We followed the female adult Western Australian population (837 942 women) across a 27-year period using linked electoral, hospital, births, deaths, and cancer records. Surgery dates were determined from hospital records, and ovarian cancer diagnoses (n = 1640) were ascertained from cancer registry records. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer incidence.
Hysterectomy without oophorectomy (n = 78 594) was not associated with risk of invasive ovarian cancer overall (HR = 0.98, 95% CI = 0.85 to 1.11) or with the most common serous subtype (HR = 1.05, 95% CI = 0.89 to 1.23). Estimates did not vary statistically significantly by age at procedure, time period, or surgical approach. However, among women with endometriosis (5.8%) or with fibroids (5.7%), hysterectomy was associated with substantially decreased ovarian cancer risk overall (HR = 0.17, 95% CI = 0.12 to 0.24, and HR = 0.27, 95% CI = 0.20 to 0.36, respectively) and across all subtypes.
Our results suggest that for most women, having a hysterectomy with ovarian conservation is not likely to substantially alter their risk of developing ovarian cancer. However, our results, if confirmed, suggest that ovarian cancer risk reduction could be considered as a possible benefit of hysterectomy when making decisions about surgical management of endometriosis or fibroids.
最近的研究对长期以来的观点提出了质疑，即子宫切除术而不切除卵巢可以预防卵巢癌。这项基于人群的纵向记录链接研究旨在探讨这种关系，包括总体情况以及根据子宫切除术的年龄、时间段、手术类型和子宫切除术的指征。
我们通过链接的选举、医院、出生、死亡和癌症记录，对西澳大利亚州的成年女性（837942 名女性）进行了长达 27 年的随访。手术日期由医院记录确定，卵巢癌诊断（n=1640）由癌症登记记录确定。我们使用 Cox 回归估计子宫切除术与卵巢癌发病率之间的关联的风险比（HR）和 95%置信区间（CI）。
子宫切除术而不切除卵巢（n=78594）与总体侵袭性卵巢癌的风险无关（HR=0.98，95%CI=0.85 至 1.11），也与最常见的浆液性亚型无关（HR=1.05，95%CI=0.89 至 1.23）。估计值在手术年龄、时间段或手术方法上没有统计学上的显著差异。然而，在患有子宫内膜异位症（5.8%）或肌瘤（5.7%）的女性中，子宫切除术与总体卵巢癌风险显著降低相关（HR=0.17，95%CI=0.12 至 0.24，HR=0.27，95%CI=0.20 至 0.36），且在所有亚型中均如此。
我们的结果表明，对于大多数女性来说，进行子宫切除术而保留卵巢不太可能显著改变她们患卵巢癌的风险。然而，如果得到证实，我们的结果表明，在决定子宫内膜异位症或肌瘤的手术治疗时，可以考虑将降低卵巢癌风险作为子宫切除术的一个可能益处。
