Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Unit of Diet, Cancer and Health, Danish Cancer Society Research Center, Copenhagen, Denmark.
Cancer Epidemiol. 2023 Jun;84:102359. doi: 10.1016/j.canep.2023.102359. Epub 2023 Apr 12.
This nationwide, register-based case-control study investigated the association between hysterectomy and risk of epithelial ovarian cancer according to histology and by history of endometriosis and menopausal hormone therapy (MHT) use.
From the Danish Cancer Registry, all women registered with epithelial ovarian cancer at age 40-79 years during 1998-2016 were identified (n = 6738). Each case was sex- and age-matched to 15 population controls using risk-set sampling. Information on previous hysterectomy on benign indication and potential confounders was retrieved from nationwide registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer according to histology, endometriosis, and use of MHT.
Hysterectomy was not associated with risk of epithelial ovarian cancer overall (OR=0.99; 95% CI 0.91 -1.09) but was associated with reduced risk of clear cell ovarian cancer (OR=0.46; 95% CI 0.28-0.78). In stratified analyses, decreased ORs associated with hysterectomy were seen in women with endometriosis (OR=0.74; 95% CI 0.50-1.10) and in non-users of MHT (OR=0.87; 95% CI 0.76-1.01). In contrast, among long-term MHT users, hysterectomy was associated with increased odds for ovarian cancer (OR=1.20; 95% CI 1.03-1.39).
Hysterectomy was not associated with epithelial ovarian cancer overall but with reduced risk of clear cell ovarian cancer. Our findings may suggest a reduced risk of ovarian cancer after hysterectomy in women with endometriosis and in MHT non-users. Interestingly our data pointed to an increased ovarian cancer risk associated with hysterectomy among long-term users of MHT.
本项全国范围内基于登记的病例对照研究调查了子宫切除术与上皮性卵巢癌风险之间的关联，关联分析基于组织学以及子宫内膜异位症和激素治疗（MHT）史。
从丹麦癌症登记处确定了 1998-2016 年期间年龄在 40-79 岁之间患有上皮性卵巢癌的所有女性（n=6738）。每个病例均通过风险集抽样按性别和年龄与 15 名人群对照相匹配。从全国范围内的登记处获取了良性指征下的既往子宫切除术和潜在混杂因素的信息。使用条件逻辑回归计算了子宫切除术与卵巢癌之间的关联的比值比（OR）及其 95%置信区间（CI），关联分析基于组织学、子宫内膜异位症和 MHT 的使用情况。
子宫切除术与上皮性卵巢癌的总体风险无关（OR=0.99；95%CI 0.91-1.09），但与透明细胞卵巢癌的风险降低相关（OR=0.46；95%CI 0.28-0.78）。在分层分析中，在患有子宫内膜异位症的女性（OR=0.74；95%CI 0.50-1.10）和非 MHT 使用者（OR=0.87；95%CI 0.76-1.01）中，与子宫切除术相关的 OR 降低。相比之下，在长期 MHT 使用者中，子宫切除术与卵巢癌的几率增加相关（OR=1.20；95%CI 1.03-1.39）。
子宫切除术与上皮性卵巢癌总体无关，但与透明细胞卵巢癌的风险降低相关。我们的研究结果表明，对于患有子宫内膜异位症和非 MHT 使用者的女性，子宫切除术后卵巢癌的风险可能降低。有趣的是，我们的数据表明，长期使用 MHT 的女性中，与子宫切除术相关的卵巢癌风险增加。
