Background

Opportunistic bilateral salpingo-oophorectomy is often offered to patients undergoing benign hysterectomy to prevent ovarian cancer, but the magnitude of risk reduction obtained with bilateral salpingo-oophorectomy in this population remains unclear and must be weighed against potential risks of ovarian hormone deficiency.

Objective

This study aimed to quantify the relative and absolute risk reduction in ovarian cancer incidence and death associated with bilateral salpingo-oophorectomy at the time of benign hysterectomy.

Study Design

We performed a population-based cohort study of all adult women (≥20 years) undergoing benign hysterectomy from 1996 to 2010 in Ontario, Canada. Patients with ovarian pathology, previous breast or gynecologic cancer, or evidence of genetic susceptibility to malignancy were excluded. Inverse probability of treatment–weighted Fine-Gray subdistribution hazard models were used to quantify the effect of bilateral salpingo-oophorectomy on ovarian cancer incidence and death while accounting for competing risks and adjusting for demographic characteristics, gynecologic conditions, and comorbidities. Analyses were performed in all women and specifically in women of postmenopausal age (≥50 years) at the time of hysterectomy.

Results

We identified 195,282 patients (bilateral salpingo-oophorectomy, 24%; ovarian conservation, 76%) with a median age of 45 years (interquartile range, 40–51 years). Over a median follow-up of 16 years (interquartile range, 12–20 years), 548 patients developed ovarian cancer (0.3%), and 16,170 patients (8.3%) died from any cause. Bilateral salpingo-oophorectomy was associated with decreased ovarian cancer incidence (hazard ratio, 0.23; 95% confidence interval, 0.14–0.38; P<.001) and decreased ovarian cancer death (hazard ratio, 0.30; 95% confidence interval, 0.16–0.57; P<.001). At 20 years follow-up, the weighted cumulative incidences of ovarian cancer were 0.08% and 0.46% with bilateral salpingo-oophorectomy and ovarian conservation, respectively, yielding an absolute risk reduction of 0.38% (95% confidence interval, 0.32–0.45; number needed to treat, 260). After restricting to women aged ≥50 years at hysterectomy, the absolute risk reduction was 0.62% (95% confidence interval, 0.47–0.77; number needed to treat, 161).

Conclusion

Bilateral salpingo-oophorectomy resulted in a significant absolute reduction in ovarian cancer among women undergoing benign hysterectomy. Population-average risk estimates derived in this study should be balanced against other potential implications of bilateral salpingo-oophorectomy to inform practice guidelines, patient decision-making, and surgical management.

中文翻译：

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在良性子宫切除术中接受双侧输卵管卵巢切除术的平均风险女性的卵巢癌发病率和死亡率

背景

机会性双侧输卵管卵巢切除术通常提供给接受良性子宫切除术以预防卵巢癌的患者，但在该人群中通过双侧输卵管卵巢切除术获得的风险降低幅度仍不清楚，必须权衡卵巢激素缺乏的潜在风险。

客观的

本研究旨在量化良性子宫切除术时与双侧输卵管卵巢切除术相关的卵巢癌发病率和死亡的相对和绝对风险降低。

学习规划

我们对 1996 年至 2010 年在加拿大安大略省接受良性子宫切除术的所有成年女性（≥20 岁）进行了一项基于人群的队列研究。排除患有卵巢病变、既往乳腺癌或妇科癌症或有遗传对恶性肿瘤易感性证据的患者。治疗加权 Fine-Gray 子分布风险模型的逆概率用于量化双侧输卵管卵巢切除术对卵巢癌发病率和死亡的影响，同时考虑竞争风险并调整人口特征、妇科疾病和合并症。对所有女性进行分析，特别是在子宫切除术时绝经后年龄（≥50 岁）的女性。

结果

我们确定了 195,282 名患者（双侧输卵管卵巢切除术，24%；卵巢保留，76%），中位年龄为 45 岁（四分位距，40-51 岁）。在 16 年的中位随访期间（四分位距，12-20 年），548 名患者（0.3%）发展为卵巢癌，16,170 名患者（8.3%）死于任何原因。双侧输卵管卵巢切除术与卵巢癌发病率降低相关（风险比，0.23；95% 置信区间，0.14-0.38；P <.001）和卵巢癌死亡率降低（风险比，0.30；95% 置信区间，0.16-0.57） ; P<.001)。在 20 年的随访中，双侧输卵管卵巢切除术和卵巢保留术的卵巢癌加权累积发病率分别为 0.08% 和 0.46%，绝对风险降低了 0.38%（95% 置信区间，0.32-0.45；数量需要治疗，260）。在子宫切除术仅限于 50 岁以上的女性后，绝对风险降低了 0.62%（95% 置信区间，0.47-0.77；需要治疗的人数，161）。

结论

双侧输卵管卵巢切除术导致接受良性子宫切除术的女性卵巢癌的绝对减少。本研究中得出的人群平均风险估计值应与双侧输卵管卵巢切除术的其他潜在影响相平衡，以便为实践指南、患者决策和手术管理提供信息。