子宫切除术与侵袭性上皮性卵巢癌和输卵管癌的关联：英国 CTOCS 队列研究。

Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS.

机构信息

MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.

Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.

出版信息

BJOG. 2022 Jan;129(1):110-118. doi: 10.1111/1471-0528.16943. Epub 2021 Oct 17.

DOI:10.1111/1471-0528.16943

PMID:34555263

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7615389/

Abstract

OBJECTIVE

To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer.

DESIGN

Prospective cohort study.

SETTING

Thirteen NHS Trusts in England, Wales and Northern Ireland.

POPULATION

A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014.

METHODS

Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association.

MAIN OUTCOME MEASURES

Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review.

RESULTS

Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85-1.13, P = 0.765).

CONCLUSIONS

This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models.

TWEETABLE ABSTRACT

Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.

摘要

目的

研究保留单侧或双侧附件的子宫切除术与卵巢癌和输卵管癌的关系。

设计

前瞻性队列研究。

地点

英格兰、威尔士和北爱尔兰的 13 个 NHs 信托机构。

人群

共有 202506 名绝经后妇女于 2001 年至 2005 年参加英国卵巢癌筛查协作试验（UKCTOCS），并随访至 2014 年 12 月 31 日。

方法

使用多种来源（问卷、医院记录、医院住院统计、国家癌症/死亡登记处、超声报告），获取有关子宫切除术（保留单侧或双侧附件）和双侧卵巢切除术、死亡、卵巢/输卵管癌诊断、随访丢失或 2014 年 12 月 31 日等结局的准确数据。使用 Cox 比例风险回归模型评估相关性。

主要观察指标

独立结果审查时的侵袭性上皮性卵巢和输卵管癌（WHO 2014 年）。

结果

报告有 41912 名（20.7%；41912/202506）妇女行保留单侧或双侧附件的子宫切除术。中位随访时间为 11.1 年（四分位间距 9.96-12.04），总计 >217 万妇女年。在接受子宫切除术的妇女中，有 0.55%（231/41912）被诊断为卵巢/输卵管癌，而在保留子宫的妇女中，有 0.59%（945/160594）被诊断为卵巢/输卵管癌。多变量分析显示，子宫切除术与侵袭性上皮性卵巢/输卵管癌之间无关联（风险比 0.98，95%CI 0.85-1.13，P=0.765）。