Yi Huan, Zhang Naiqi, Sundquist Jan, Sundquist Kristina, Zheng Xiangqin, Ji Jianguang
Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
National Key Gynecology Clinical Specialty Construction Institution of China, Fujian Provincial Key Gynecology Clinical Specialty, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
PLoS Med. 2025 Jul 7;22(7):e1004639. doi: 10.1371/journal.pmed.1004639. eCollection 2025 Jul.
Opportunistic bilateral salpingo-oophorectomy (BSO) is recommended in women who have undergone a hysterectomy due to gynecological carcinomas and/or in women with genetic indications, especially for women who do not intend to conceive. However, there is ongoing debate about whether BSO should be recommended in premenopausal women, due to the early cessation of estradiol because of BSO which is linked to several health concerns, including coronary artery disease (CAD) and osteoporosis. This study aims to explore whether ovarian cancer can be prevented by unilateral salpingo-oophorectomy (USO) while not affecting the long-term risk of CAD and osteoporosis.
By accessing the Swedish national registries, this retrospective cohort study included 42,306 women who underwent USO between 1993 and 2018 before the age of 50 years. These women were randomly matched with 211,530 women who had not undergone USO using a propensity score matching approach to ensure comparability between the groups. Follow-up started on the date of USO operation and continued until the earliest occurrence of the following events: diagnosis of specific outcomes of interest, death from any cause, or the end of the study period (31st December 2018). Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of overall and histology-specific ovarian cancer, CAD, and osteoporosis associated with USO. After a median follow-up of 13 years, our analyses revealed that USO was not associated with subsequent risk of CAD (HR = 1.02, 95% CI [0.95, 1.09]) and osteoporosis (HR = 1.06, 95% CI [0.98, 1.16]). However, USO was significantly associated with a reduced risk of high-grade serous ovarian carcinoma (HR = 0.64, 95% CI [0.45, 0.92]). No differences were found when the analyses were stratified by hysterectomy. The main limitation of the study was that some confounding factors, such as BRCA1/2 pathological mutant status, were not available in our database.
Our study suggests that USO reduces the risk of HGSCs but was not associated with CAD or osteoporosis after a median 13-year follow-up. These results suggest that USO may be a safer option than BSO for lowering ovarian cancer risk in premenopausal women, as it could avoid the negative health effects of early menopause.
对于因妇科癌症接受子宫切除术的女性和/或有遗传指征的女性，尤其是不打算怀孕的女性，建议进行择期双侧输卵管卵巢切除术（BSO）。然而，对于是否应建议绝经前女性进行BSO存在持续争议，因为BSO导致雌二醇过早停止分泌，这与包括冠状动脉疾病（CAD）和骨质疏松症在内的多种健康问题有关。本研究旨在探讨单侧输卵管卵巢切除术（USO）能否预防卵巢癌，同时又不影响CAD和骨质疏松症的长期风险。
通过访问瑞典国家登记处，这项回顾性队列研究纳入了1993年至2018年间50岁之前接受USO的42306名女性。使用倾向评分匹配方法将这些女性与211530名未接受USO的女性进行随机匹配，以确保两组之间具有可比性。随访从USO手术日期开始，持续到以下事件最早发生：诊断出感兴趣的特定结局、任何原因导致的死亡或研究期结束（2018年12月31日）。使用Cox回归模型计算与USO相关的总体和组织学特异性卵巢癌、CAD和骨质疏松症的风险比（HRs）和95%置信区间（CIs）。中位随访13年后，我们的分析显示USO与随后的CAD风险（HR = 1.
