Uptake and Predictors of Opportunistic Salpingectomy for Ovarian Cancer Risk Reduction in the United States.
Uptake and Predictors of Opportunistic Salpingectomy for Ovarian Cancer Risk Reduction in the United States.
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DOI：
10.1158/1940-6207.capr-21-0121
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Visvanathan K
中科院分区：
文献类型：
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作者：
Karia PS;Joshu CE;Visvanathan K
有证据表明，高级别浆液性卵巢癌起源于输卵管，导致机会性输卵管切除术 (OS) 的出现，作为降低卵巢癌风险的一种方法。在美国，一些国家协会现在建议在中等风险女性中使用 OS 代替输卵管结扎术或良性子宫切除术。然而，关于 OS 在临床实践中采用的数据有限。我们检查了 2010 年至 2017 年全国住院和门诊索赔样本 (N=48,231,235) 中 OS 的采用情况和预测因素。计算OS的发生率，并使用间断时间序列分析来量化国家指南发布之前（2010-2013年）和之后（2015-2017年）发生率的变化。使用泊松回归检查操作系统使用的预测因素。从2010年至2017年，绝育手术和子宫切除术期间OS的年龄调整发生率分别增加了17.8倍（95% CI：16.2-19.5）和7.6倍（95% CI：5.5-10.4）。快速增长（按年龄调整的季度增长率在 109% 至 250% 之间）与指南发布的时间一致。在多变量调整分析中，OS 使用在年轻女性中更为常见，并且因地理区域、农村地区、家族史/遗传易感性、手术指征、住院/门诊环境和潜在合并症而存在显着差异。在仅限于具有乳腺癌/卵巢癌家族史/遗传易感性的女性的分析中，发现了类似的 OS 摄取差异。我们的结果强调了高风险和一般风险女性的 OS 摄取存在显着差异。需要确定最能从 OS 中受益的女性群体，并找出公平采用 OS 的障碍。尽管总体疗效的数据有限，但用于降低卵巢癌风险的机会性输卵管切除术已在美国迅速采用，但因人口和临床因素的不同而采用的情况存在显着差异。需要研究检查机会性输卵管切除术的障碍以及机会性输卵管切除术的长期有效性和潜在的不利影响。
Evidence suggesting that high-grade serous ovarian cancers originate in the fallopian tubes has led to the emergence of opportunistic salpingectomy (OS) as an approach to reduce ovarian cancer risk. In the U.S., some national societies now recommend OS in place of tubal ligation for sterilization or during a benign hysterectomy in average-risk women. However, limited data exist on the adoption of OS in clinical practice. We examined the uptake and predictors of OS in a nationwide sample of inpatient and outpatient claims (N=48,231,235) from 2010-2017. Incidence rates of OS were calculated, and an interrupted time-series analysis was used to quantify changes in rates before (2010-2013) and after (2015-2017) national guideline release. Predictors of OS use were examined using Poisson regression. From 2010-2017, the age-adjusted incidence rate of OS for sterilization and OS during hysterectomy increased 17.8-fold (95% CI: 16.2-19.5) and 7.6-fold (95% CI: 5.5-10.4), respectively. The rapid increase (age-adjusted increase in quarterly rates of between 109% and 250%) coincided with the time of guideline release. In multivariable-adjusted analyses, OS use was more common in young women and varied significantly by geographic region, rurality, family history/genetic susceptibility, surgical indication, inpatient/outpatient setting, and underlying comorbidities. Similar differences in OS uptake were noted in analyses limited to women with a family history/genetic susceptibility to breast/ovarian cancer. Our results highlight significant differences in OS uptake in both high- and average-risk women. Defining subsets of women who would benefit most from OS and identifying barriers to equitable OS uptake is needed. Despite limited data on overall efficacy, opportunistic salpingectomy for ovarian cancer risk reduction has been rapidly adopted in the U.S. with significant variation in uptake by demographic and clinical factors. Studies examining barriers to opportunistic salpingectomy access and the long-term effectiveness and potential adverse effects of opportunistic salpingectomy are needed.