A Case-control Study Of Obstetrical And Gynecological Surgery And The Risk Of Epithelial Ovarian Cancer

Objective:As the volume of obstetrical and gynecological procedures increases,there is increasing concern about the long-term effects of obstetrical and gynecological procedures on patients.Tubal ligation has been shown to be associated with a reduced risk of epithelial ovarian cancer(EOC),and most previous studies have shown that hysterectomy with preservation of at least one ovary reduces the risk of EOC,and in recent years studies have reported that hysterectomy is a risk factor for EOC.There are fewer domestic studies correlating obstetrical and gynecological surgery with the risk of developing EOC.In this study,we investigated the relationship between obstetrical and gynecological surgery and the risk of epithelial ovarian cancer through a case-control study of inpatients.Methods:A case-control study based on inpatients was used,and 974 patients with primary EOC first diagnosed between 01 2015 and 01 2021 at the Affiliated Hospital of Qingdao University and 985 age-matched non-EOC patients hospitalized during the same period were finally selected according to the inclusion and exclusion criteria.The history of obstetrical and gynaecological surgery such as tubectomy,tubal ligation,hysterectomy,myomectomy,caesarean section,ovarian cyst debridement,endometriosis and chronic pelvic inflammatory disease and related medical history of the 2 groups were compared to analyse the effect of obstetrical and gynaecological surgery history on the risk of EOC.Results:1.There was no statistically significant difference between the two groups in terms of body mass index,age at menarche,age at menopause,number of births,use of oral contraceptives and smoking,all p>0.052.On univariate analysis,there was a statistically significant difference between the two groups when comparing unilateral salpingo-oophorectomy(P=0.029),bilateral salpingo-oophorectomy(P=0.020),tubal ligation(P=0.042)and hysterectomy(P=0.005).There was no statistically significant difference between the two groups when comparing myomectomy,caesarean section and ovarian cyst debridement(P>0.05).On multifactorial analysis,unilateral salpingo-oophorectomy(OR=0.368,95% CI0.152-0.890),bilateral salpingo-oophorectomy(OR=0.114,95% CI 0.014-0.920)and tubal ligation(OR=0.749,95% CI 0.579-0.970)reduced the risk of developing EOC.Hysterectomy(OR=1.752,95% CI 1.225-2.506)increased the risk factors for the development of EOC.3.The surgical routes for hysterectomy in the EOC group were laparoscopic in 10cases(11.76%),open in 66 cases(77.65%)and transvaginal in 9 cases(10.59%),while the surgical routes for hysterectomy in the non-EOC group were laparoscopic in 11 cases(20.37%),open in 29 cases(53.70%)and transvaginal in 14 cases(25.93%).There was a statistically significant difference in the surgical route compared between the two groups(~2=9.083,p=0.011).There were no statistically significant differences in age at the time of hysterectomy,reason for hysterectomy,or adnexal resection at the time of hysterectomy between the two groups,all P>0.05.4.Unilateral salpingo-oophorectomy(P=0.014)and bilateral salpingo-oophorectomy(P=0.749)were associated with the risk of developing type Ⅱ EOC,tubal ligation was associated with the risk of developing both type Ⅰ EOC(P=0.025)and type Ⅱ EOC(P=0.047),and hysterectomy was a risk factor for type Ⅱ EOC(P=0.001).5.There was a statistically significant difference between the two groups for history of endometriosis(P=0.014)and no statistically significant difference between the two groups for history of chronic pelvic inflammatory disease(P=0.079).For the history of endometriosis,there was a statistically significant difference between the type Ⅰ EOC patients compared to the non-EOC group(P=0.000);there was no statistically significant difference between the type Ⅱ EOC patients compared to the non-EOC group(P=0.267).Conclusion:1.Tubectomy and tubal ligation reduce the risk of EOC,and hysterectomy may increase the risk of EOC.2.The effect of open hysterectomy on the risk of EOC is perhaps more significant than that of laparoscopic and transvaginal surgery.3.The protective effect of tubal ligation on type Ⅰ and type Ⅱ EOC and hysterectomy mainly increase the risk of type Ⅱ EOC.4.Endometriosis increases the risk of EOC,mainly affecting type Ⅰ EOC.