Duus Alberte Hjorth, Zheng Guoqiao, Baandrup Louise, Faber Mette Tuxen, Kjær Susanne K
Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark.
Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark.
Gynecol Oncol. 2023 Oct;177:125-131. doi: 10.1016/j.ygyno.2023.08.016. Epub 2023 Sep 6.
Recent theories propose that most epithelial ovarian cancer (EOC), depending on histological type, originate from other gynecological tissues and involve the ovary secondarily. According to these theories, any protective effect of salpingectomy and tubal ligation may vary by histological type. The study aim was to examine the association between salpingectomy and tubal ligation, respectively, and risk of EOC, with a focus on associations specific for histological types.
We identified EOC cases and matching controls in national registries and gathered information on surgical procedures and potential confounders. Conditional logistic regression was used to estimate odds ratio (OR) with 95% confidence interval (CI) of EOC related to salpingectomy and tubal ligation, respectively, overall and stratified by histological type. Furthermore, we investigated the association according to timing of the procedures.
Our study comprised 16,822 EOC cases. Each case was matched with 40 controls. There was an overall EOC risk reduction after unilateral (OR = 0.73; 95% CI: 0.60-0.87) and bilateral salpingectomy (OR = 0.46; 95% CI: 0.31-0.67). A slight risk reduction was seen among women with previous tubal ligation (OR = 0.91; 95% CI: 0.83-0.99). For salpingectomy, the risk reduction increased with increasing time since the surgical procedure and was only present among women younger than 50 years at salpingectomy. Unilateral and bilateral salpingectomy was associated with a risk reduction for most histological types.
The association between previous salpingectomy and reduced risk of several histological subtypes of EOC supports the suggested theories about the site of origin of EOC and may be of clinical importance.
近期理论提出，大多数上皮性卵巢癌（EOC），根据组织学类型，起源于其他妇科组织并继发累及卵巢。根据这些理论，输卵管切除术和输卵管结扎的任何保护作用可能因组织学类型而异。本研究的目的是分别研究输卵管切除术和输卵管结扎与EOC风险之间的关联，重点关注特定组织学类型的关联。
我们在国家登记处确定了EOC病例和匹配的对照，并收集了手术程序和潜在混杂因素的信息。采用条件逻辑回归分别估计与输卵管切除术和输卵管结扎相关的EOC的比值比（OR）及95%置信区间（CI），总体及按组织学类型分层。此外，我们根据手术时间调查了这种关联。
我们的研究包括16,822例EOC病例。每个病例与40名对照匹配。单侧输卵管切除术（OR = 0.73；95%CI：0.60 - 0.87）和双侧输卵管切除术后总体EOC风险降低（OR = 0.46；95%CI：0.31 - 0.67）。既往有输卵管结扎的女性中可见轻微的风险降低（OR = 0.91；95%CI：0.83 - 0.99）。对于输卵管切除术，风险降低随着手术时间的增加而增加，且仅在输卵管切除时年龄小于50岁的女性中存在。单侧和双侧输卵管切除术与大多数组织学类型的风险降低相关。
既往输卵管切除术与几种EOC组织学亚型风险降低之间的关联支持了关于EOC起源部位的提出的理论，可能具有临床重要性。
