Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
JAMA Netw Open. 2023 Aug 1;6(8):e2327198. doi: 10.1001/jamanetworkopen.2023.27198.
A body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian cancers. Consequently, salpingectomy is now considered for permanent contraception (in lieu of tubal ligation) or ovarian cancer prevention (performed opportunistically at the time of surgical procedures for benign gynecologic conditions).
To evaluate the association between salpingectomy and the risk of invasive epithelial ovarian, fallopian tube, and peritoneal cancer.
DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study included all women aged 18 to 80 years who were eligible for health care services in Ontario, Canada. Participants were identified using administrative health databases from Ontario between January 1, 1992, and December 31, 2019. A total of 131 516 women were included in the primary (matched) analysis. Women were followed up until December 31, 2021.
Salpingectomy (with and without hysterectomy) vs no pelvic procedure (control condition) among women in the general population.
Women with a unilateral or bilateral salpingectomy in Ontario between April 1, 1992, and December 31, 2019, were matched 1:3 to women with no pelvic procedure from the general population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for ovarian, fallopian tube, and peritoneal cancer combined.
Among 131 516 women (mean [SD] age, 42.2 [7.6] years), 32 879 underwent a unilateral or bilateral salpingectomy, and 98 637 did not undergo a pelvic procedure. After a mean (range) follow-up of 7.4 (0-29.2) years in the salpingectomy group and 7.5 (0-29.2) years in the nonsurgical control group, there were 31 incident cancers (0.09%) and 117 incident cancers (0.12%), respectively (HR, 0.82; 95% CI, 0.55-1.21). The HR for cancer incidence was 0.87 (95% CI, 0.53-1.44) when comparing those with salpingectomy vs those with hysterectomy alone.
In this cohort study, no association was found between salpingectomy and the risk of ovarian cancer; however, this observation was based on few incident cases and a relatively short follow-up time. Studies with additional years of follow-up are necessary to define the true level of potential risk reduction with salpingectomy, although longer follow-up will also be a challenge unless collaborative efforts that pool data are undertaken.
大量的病理学和临床证据支持输卵管是高级别浆液性卵巢癌的主要起源部位。因此，输卵管切除术现在被认为是一种永久性避孕方法（替代输卵管结扎术）或卵巢癌预防方法（在妇科良性疾病手术时偶然进行）。
评估输卵管切除术与侵袭性上皮性卵巢癌、输卵管癌和腹膜癌风险之间的关联。
设计、设置和参与者：这项基于人群的回顾性队列研究纳入了所有年龄在 18 岁至 80 岁之间、有资格在加拿大安大略省接受医疗服务的女性。参与者是通过安大略省的行政健康数据库于 1992 年 1 月 1 日至 2019 年 12 月 31 日期间确定的。共有 131516 名女性纳入了主要（匹配）分析。女性随访至 2021 年 12 月 31 日。
在普通人群中，进行单侧或双侧输卵管切除术（伴有或不伴有子宫切除术）的女性与未进行盆腔手术的女性（对照条件）。
在安大略省，于 1992 年 4 月 1 日至 2019 年 12 月 31 日期间进行单侧或双侧输卵管切除术的女性，与普通人群中未进行盆腔手术的女性按 1:3 进行匹配。使用 Cox 比例风险回归模型估计卵巢癌、输卵管癌和腹膜癌的合并风险比（HR）和 95%CI。
在 131516 名女性（平均[SD]年龄，42.2[7.6]岁）中，32879 名女性接受了单侧或双侧输卵管切除术，98637 名女性未接受盆腔手术。在输卵管切除术组的平均（范围）随访 7.4（0-29.2）年和非手术对照组的 7.5（0-29.2）年后，分别有 31 例（0.09%）和 117 例（0.12%）发生癌症（HR，0.82；95%CI，0.55-1.21）。与单独行子宫切除术相比，行输卵管切除术的女性癌症发病率的 HR 为 0.87（95%CI，0.53-1.44）。
在这项队列研究中，未发现输卵管切除术与卵巢癌风险之间存在关联；然而，这一观察结果基于少数病例和相对较短的随访时间。需要进行具有更多随访年份的研究来确定输卵管切除术潜在风险降低的真实水平，尽管除非开展数据共享的合作努力，否则随着随访时间的延长，这也将是一个挑战。
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