针对卵巢癌预防的风险降低型早期输卵管切除术联合延迟卵巢切除术的态度：一项队列研究。
Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study.
机构信息
Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.
Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
出版信息
BJOG. 2021 Mar;128(4):714-726. doi: 10.1111/1471-0528.16424. Epub 2020 Aug 16.
OBJECTIVE
To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk.
DESIGN
Multicentre, cohort, questionnaire study (IRSCTN:12310993).
SETTING
United Kingdom (UK).
POPULATION
UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups.
METHODS
Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes.
MAIN OUTCOMES
RRESDO acceptability, menopausal sequelae, satisfaction/regret.
RESULTS
In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2-0.9, P = 0.025).
CONCLUSION
Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness.
TWEETABLE ABSTRACT
RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.
目的
确定降低风险的早期输卵管卵巢切除术和延迟卵巢切除术（RRESDO）的可接受性，以及手术预防对有卵巢癌（OC）风险增加的女性绝经后症状/满意度/遗憾的影响。
设计
多中心、队列、问卷调查研究（IRSCTN：12310993）。
地点
英国（英国）。
人群
≥ 18 岁、有 OC 风险增加、有/无 RRSO 病史的英国女性，通过专科家族性癌症/遗传诊所和 BRCA 支持小组确定。
方法
参与者完成了 39 项问卷调查。使用描述性统计描述基线特征。逻辑/线性回归模型分析了变量对 RRESDO 可接受性和健康结果的影响。
主要结果
RRESDO 的可接受性、绝经后症状、满意度/遗憾。
结果
在总共 683 名参与者中，346 名接受了降低风险的输卵管卵巢切除术（RRSO）。在未接受 RRSO 的绝经前妇女中，69.1%（181/262）发现参与一项提供 RRESDO 的研究是可以接受的。担心性功能障碍的绝经前妇女更有可能接受 RRESDO（优势比[OR] = 2.9，95%CI 1.2-7.7，P = 0.025）。在接受 RRSO 前经历过性功能障碍的绝经前妇女，事后更有可能接受 RRESDO（OR = 5.3，95%CI 1.2-27.5，P < 0.031）。在接受 RRSO 的所有绝经前妇女中，88.8%（143/161）和 95.2%（80/84）的绝经后妇女对她们的决定感到满意，而 9.4%（15/160）的绝经前妇女和 1.2%（1/81）的绝经后妇女对她们的决定感到遗憾。无乳腺癌（BC）的绝经前妇女中，HRT 使用率为 74.1%（80/108）。HRT 使用并未显著影响满意度/遗憾程度，但确实减轻了阴道干燥症状（OR = 0.4，95%CI 0.2-0.9，P = 0.025）。
结论
数据显示 RRESDO 的可接受性很高，特别是对担心性功能障碍的妇女。尽管 RRSO 的满意度仍然很高，但绝经前妇女的后悔率远高于绝经后妇女。绝经前 RRSO 后使用 HRT 不会增加满意度，但确实可以减轻阴道干燥。
推文摘要
RRESDO 在有卵巢癌风险增加的绝经前妇女中具有较高的可接受性，尤其是那些担心性功能障碍的妇女。
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