Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies.
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Sieh Weiva, Salvador Shannon, McGuire Valerie, Weber Rachel Palmieri, Terry Kathryn L, Rossing Mary Anne, Risch Harvey, Wu Anna H, Webb Penelope M, Moysich Kirsten, Doherty Jennifer A, Felberg Anna, Miller Dianne, Jordan Susan J, Australian Cancer Study (Ovarian Cancer), Australian Ovarian Cancer Study Group, Goodman Marc T, Lurie Galina, Chang-Claude Jenny, Rudolph Anja, Kjær Susanne Krüger, Jensen Allan, Høgdall Estrid, Bandera Elisa V, Olson Sara H, King Melony G, Rodriguez-Rodriguez Lorna, Kiemeney Lambertus A, Marees Tamara, Massuger Leon F, van Altena Anne M, Ness Roberta B, Cramer Daniel W, Pike Malcolm C, Pearce Celeste Leigh, Berchuck Andrew, Schildkraut Joellen M, Whittemore Alice S, Ovarian Cancer Association Consortium
Аннотация
METHODS: We pooled primary data from 13 population-based case-control studies, including 10,157 patients with ovarian cancer (7942 invasive; 2215 borderline) and 13,904 control women. Invasive cases were analysed by histological type, grade and stage, and borderline cases were analysed by histological type. Pooled odds ratios were estimated using conditional logistic regression to match on site, race/ethnicity and age categories, and to adjust for age, oral contraceptive use duration and number of full-term births.
RESULTS: Tubal ligation was associated with significantly reduced risks of invasive serous (OR, 0.81; 95% CI, 0.74-0.89; P < 0.001), endometrioid (OR, 0.48; 95% CI, 0.40-0.59; P < 0.001), clear cell (OR, 0.52; 95% CI, 0.40-0.67; P < 0.001) and mucinous (OR, 0.68; 95% CI, 0.52-0.89; P = 0.005) cancers. The magnitude of risk reduction was significantly greater for invasive endometrioid (P < 0.0001) and clear cell (P = 0.0018) than for serous cancer. No significant associations were found with borderline serous or mucinous tumours.
CONCLUSIONS: We found that the protective effects of tubal ligation on ovarian cancer risk were subtype-specific. These findings provide insights into distinct aetiologies of ovarian cancer subtypes and mechanisms underlying the protective effects of tubal ligation.