Salpingectomy for ectopic pregnancy reduces ovarian cancer risk-a nationwide study.

Yen JC, Wu TI, Stone R, Wang TL, Kala Visvanathan, Chen LY, Hsu MH, Ie−Ming Shih
JNCI cancer spectrum · 2024 · doi:10.1093/jncics/pkae027 · PMID:38588567 · PMC11078587
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This nationwide study found that salpingectomy for ectopic pregnancy significantly reduces the incidence of epithelial ovarian cancer, supporting the hypothesis that fallopian tubes are a primary tissue origin for these malignancies.

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This nationwide study utilized deidentified data from the National Health Insurance Research Database in Taiwan to evaluate the association between salpingectomy performed for ectopic pregnancy and subsequent ovarian cancer risk. The authors conducted a statistical analysis comparing incidence rates between women who underwent salpingectomy and those who did not, aiming to determine if removing the fallopian tubes provides a protective effect against malignancy. The research explicitly acknowledges funding support from various institutions and notes that the findings are derived from retrospective observational data, which inherently carries limitations regarding confounding variables and causality. Relevance to endometriosis: The paper does not discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Recent studies propose fallopian tubes as the tissue origin for many ovarian epithelial cancers. To further support this paradigm, we assessed whether salpingectomy for treating ectopic pregnancy had a protective effect using the Taiwan Longitudinal National Health Research Database. We identified 316 882 women with surgical treatment for ectopic pregnancy and 3 168 820 age- and index-date-matched controls from 2000 to 2016. In a nested cohort, 91.5% of cases underwent unilateral salpingectomy, suggesting that most surgically managed patients have salpingectomy. Over a follow-up period of 17 years, the ovarian carcinoma incidence was 0.0069 (95% confidence interval [CI] = 0.0060 to 0.0079) and 0.0089 (95% CI = 0.0086 to 0.0092) in the ectopic pregnancy and the control groups, respectively (P < .001). After adjusting the events to per 100 person-years, the hazard ratio (HR) in the ectopic pregnancy group was 0.70 (95% CI = 0.61 to 0.80). The risk reduction occurred only in epithelial ovarian cancer (HR = 0.73, 95% CI = 0.63 to 0.86) and not in non-epithelial subtypes. These findings show a decrease in ovarian carcinoma incidence after salpingectomy for treating ectopic pregnancy.
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Ack

We acknowledge the above funding for the salary support of some authors who were involved in the design, analysis, and manuscript preparation of this study. In addition, the NSTC grant supports the collection, analysis, and interpretation of the data.

Data

The deidentified NHIRD data are available for researchers to access following the application and authorization by the Department of Health and Welfare Data Center in Taiwan ( 23 ).

Author

Ju-Chuan Yen, MD (Conceptualization; Formal analysis; Investigation; Methodology; Writing—original draft), Tzu-I Wu, MD (Conceptualization; Investigation), Rebecca Stone, MD (Conceptualization; Writing—original draft; Writing—review & editing), Tian-Li Wang, PhD (Conceptualization; Resources; Writing—original draft; Writing—review & editing), Kala Visvanathan, MD (Conceptualization; Investigation; Methodology; Writing—review & editing), Li-Ying Chen, BS (Data curation; Resources; Validation), Min-Huei Hsu, MD, PhD (Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Supervision; Validation), Ie-Ming Shih, MD, PhD (Conceptualization; Funding acquisition; Investigation; Writing—original draft; Writing—review & editing).

Funding

This study is supported by the Richard W. TeLinde Endowment, the Johns Hopkins University (to IMS), Break Through Cancer-IOC (to RS and IMS), NIH/NCI P50 CA228991 (to IMS and TLW), and NSTC112-2321-B-038-005 (to MHH).

Conflicts

None of the authors claims any conflict of interest in this study.

Contrib Info

Ju-Chuan Yen, Department of Ophthalmology, Taipei Ren-Ai Branch, and Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan. Tzu-I Wu, Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Rebecca Stone, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Tian-Li Wang, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. Kala Visvanathan, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. Li-Ying Chen, Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan. Min-Huei Hsu, Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan. Ie-Ming Shih, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Associated Data

The deidentified NHIRD data are available for researchers to access following the application and authorization by the Department of Health and Welfare Data Center in Taiwan ( 23 ).

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