Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study.
Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study.
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DOI：
10.1097/aog.0b013e3181a11c64
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发表时间：
2009-05
影响因子：
7.2
通讯作者：
Manson JE
中科院分区：
文献类型：
--
作者：
Parker WH;Broder MS;Chang E;Feskanich D;Farquhar C;Liu Z;Shoupe D;Berek JS;Hankinson S;Manson JE
报告卵巢切除术或卵巢保留术后的长期健康结局和死亡率。我们对29，380名参与护士健康研究的女性进行了一项前瞻性观察性研究，这些女性因良性疾病接受了子宫切除术; 16，345名（55.6%）接受了双侧卵巢切除术的子宫切除术，13，035名（44.4%）接受了保留卵巢的子宫切除术。我们评估了冠心病（CHD）、中风、乳腺癌、卵巢癌、肺癌、结直肠癌、总癌症、髋部骨折、肺栓塞和全因死亡的事件或死亡。超过24年的随访，对于接受子宫切除术和双侧卵巢切除术的女性，与保留卵巢的女性相比，总死亡率的多变量风险比（HR）为1.12（95%CI 1.03，1.21），致命性和非致命性CHD的多变量风险比（HR）为1.17（95%CI 1.02，1.35），中风的多变量风险比（HR）为1.14（95%CI 0.98，1.33）。虽然乳房的风险（HR 0.75 95% CI 0.68，0.84），卵巢（HR 0.04 95% CI 0.01，0.09，NNT = 220）和总癌症（HR 0.92，95% CI 0.86，0.98）卵巢切除术后肺癌发病率降低（HR =1.26，95% CI 1.02，1.56，NNH = 190）和总癌症死亡率（HR=1.17，95% CI 1.04，1.32）增加。对于从未使用雌激素治疗的患者，50岁以前双侧卵巢切除术与全因死亡率、冠心病和中风的风险增加相关。手术后的寿命约为35年，预计每进行9次卵巢切除术就会增加1例死亡。与保留卵巢相比，良性疾病行子宫切除术时行双侧卵巢切除术可降低乳腺癌和卵巢癌的风险，但增加全因死亡率、致死性和非致死性冠心病和肺癌的风险。没有分析或年龄组卵巢切除术与生存率增加相关。
To report long-term health outcomes and mortality after oophorectomy or ovarian conservation. We conducted a prospective, observational study of 29,380 women participants of the Nurses’ Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes. Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy, compared with ovarian conservation, the multivariable hazard ratios (HR) were 1.12 (95% CI 1.03, 1.21) for total mortality, 1.17 (95% CI 1.02, 1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98, 1.33) for stroke. Although the risks of breast (HR 0.75 95% CI 0.68, 0.84), ovarian (HR 0.04 95% CI 0.01, 0.09, NNT = 220), and total cancers (HR 0.92 95% CI 0.86, 0.98) decreased after oophorectomy, lung cancer incidence (HR =1.26, 95% CI 1.02, 1.56, NNH = 190) and total cancer mortality (HR=1.17, 95% CI 1.04, 1.32) increased. For never-users of estrogen therapy, bilateral oophorectomy before age 50 was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span following surgery, one additional death would be expected for every 9 oophorectomies performed. Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer, but an increased risk of all-cause mortality, fatal and non-fatal coronary heart disease, and lung cancer. In no analysis or age-group was oophorectomy associated with increased survival.