Department of Internal Medicine, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Academic Research Organization, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Eur J Endocrinol. 2021 Jan;184(1):143-151. doi: 10.1530/EJE-20-0686.
Little is known about the role of estrogen in thyroid cancer development. We aimed to evaluate the association between hysterectomy or bilateral salpingo-oophorectomy (BSO) and the risk of subsequent thyroid cancer.
A nationwide cohort study.
Data from the Korea National Health Insurance Service between 2002 and 2017 were used. A total of 78 961 and 592 330 women were included in the surgery group and no surgery group, respectively. The surgery group was categorized into two groups according to the extent of surgery: hysterectomy with ovarian conservation (hysterectomy-only) and BSO with or without hysterectomy (BSO).
During 8 086 396.4 person-years of follow-up, 12 959 women developed thyroid cancer. Women in the hysterectomy-only (adjusted hazard ratio = 1.7, P < 0.001) and BSO (adjusted hazard ratio = 1.4, P < 0.001) groups had increased risk of thyroid cancer compared to those in the no surgery group. In premenopausal women, hysterectomy-only (adjusted hazard ratio = 1.7, P < 0.001) or BSO (adjusted hazard ratio = 1.4, P < 0.001) increased the risk of subsequent thyroid cancer, irrespective of hormone therapy, whereas, there was no significant association between hysterectomy-only (P = 0.204) or BSO (P = 0.857) and thyroid cancer development in postmenopausal women who had undergone hormone therapy.
Our findings do not support the hypotheses that sudden or early gradual decline in estrogen levels is a protective factor in the development of thyroid cancer, or that exogenous estrogen is a risk factor for thyroid cancer.
关于雌激素在甲状腺癌发展中的作用知之甚少。本研究旨在评估子宫切除术或双侧输卵管卵巢切除术（BSO）与随后发生甲状腺癌的风险之间的关系。
一项全国性队列研究。
使用韩国国家健康保险服务局 2002 年至 2017 年的数据。共纳入 78961 名和 592330 名女性分别进入手术组和无手术组。根据手术范围，手术组分为两组：子宫切除术伴卵巢保留（子宫切除术仅）和 BSO 伴或不伴子宫切除术（BSO）。
在 8086396.4 人年的随访期间，有 12959 名女性发生甲状腺癌。与无手术组相比，子宫切除术仅（调整后的危险比=1.7，P<0.001）和 BSO（调整后的危险比=1.4，P<0.001）组的女性发生甲状腺癌的风险增加。在绝经前女性中，子宫切除术仅（调整后的危险比=1.7，P<0.001）或 BSO（调整后的危险比=1.4，P<0.001）增加了随后发生甲状腺癌的风险，而激素治疗与子宫切除术仅（P=0.204）或 BSO（P=0.857）与绝经后女性甲状腺癌发展之间无显著关联。
本研究结果不支持雌激素水平突然或早期逐渐下降是甲状腺癌发生的保护因素的假说，也不支持外源性雌激素是甲状腺癌的危险因素的假说。
