Moufarrij Sara, Hazimeh Dana, Rockwell Tori, Ettorre Victoria, Dagher Christian, Abu-Rustum Nadeem R, Chi Dennis S, Long Kara C, Stone Rebecca L
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of OBGYN, Duke School of Medicine, Durham, North Carolina.
JAMA Surg. 2025 Aug 13. doi: 10.1001/jamasurg.2025.2810.
The impact of salpingectomy on the prevention of high-grade serous cancer (HGSC) at the population level is currently under investigation.
To determine the frequency of missed opportunity for salpingectomy with/without oophorectomy among patients diagnosed with HGSC.
DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods, multi-institutional retrospective study included patients diagnosed with HGSC at 2 academic medical centers between 2015 and 2021. Clinicopathologic data were abstracted from medical records. An electronic survey was also administered to members of a national ovarian cancer organization who self-identified as having had an HGSC diagnosis. The retrospective cohort included 1877 patients with HGSC and the survey included 917 respondents, of which 348 were diagnosed with HGSC. These data were analyzed from May 2023 and August 2023.
Missed opportunity was defined as a history of either a surgical procedure resulting in permanent contraception (bilateral tubal ligation or hysterectomy without concurrent salpingectomy) at any age or another abdomino-pelvic surgery at 45 years or older when salpingectomy could have been performed 1 year or more preceding a diagnosis of HGSC.
The proportion of HGSCs that could have been prevented with salpingectomy.
Of the 445 patients (23.7%) with missed opportunities for salpingectomy in the retrospective cohort, 241 had a tubal ligation/hysterectomy (54.2%) and 204 had other abdomino-pelvic surgeries (45.8%). Cholecystectomy, hernia repair, and bowel surgeries were more commonly performed for patients 45 years or older than for younger patients. Among the 348 survey respondents, missed opportunity was reported by 54 (15.5%). The study team uncovered a 43.2% missed opportunity rate for germline genetic testing and reflex risk-reducing surgery among patients with an affected first-degree relative in the retrospective cohort.
A considerable proportion of patients with HGSC missed opportunities for risk assessment with genetic testing and for surgical prevention. Given the lack of effective screening and limited treatment options for HGSC, eradicating it requires addressing the full spectrum of missed opportunities.
输卵管切除术对人群层面高级别浆液性癌（HGSC）预防的影响目前正在研究中。
确定HGSC确诊患者中接受或未接受卵巢切除术的情况下错失输卵管切除术机会的频率。
设计、地点和参与者：这项混合方法、多机构回顾性研究纳入了2015年至2021年期间在2家学术医疗中心被诊断为HGSC的患者。临床病理数据从病历中提取。还对一个全国性卵巢癌组织中自我认定患有HGSC的成员进行了电子调查。回顾性队列包括1877例HGSC患者，调查包括917名受访者，其中348人被诊断为HGSC。这些数据于2023年5月至2023年8月进行分析。
错失机会被定义为在任何年龄进行导致永久避孕的手术（双侧输卵管结扎或未同时进行输卵管切除术的子宫切除术）的病史，或在45岁及以上进行其他腹盆腔手术的病史，而在HGSC诊断前1年或更早本可进行输卵管切除术。
可通过输卵管切除术预防的HGSC比例。
在回顾性队列中，445例（23.7%）有错失输卵管切除术机会的患者中，241例进行了输卵管结扎/子宫切除术（54.2%），204例进行了其他腹盆腔手术（45.8%）。45岁及以上患者比年轻患者更常进行胆囊切除术、疝气修补术和肠道手术。在348名调查受访者中，54人（15.5%）报告有错失机会。研究团队发现回顾性队列中一级亲属受影响的患者进行种系基因检测和反射性降低风险手术的错失机会率为43.2%。
相当一部分HGSC患者错失了基因检测风险评估和手术预防的机会。鉴于HGSC缺乏有效的筛查且治疗选择有限，根除该病需要解决所有错失的机会。
