Ovarian conservation at the time of hysterectomy for benign disease

被引:205
作者
Parker, WH
Broder, MS
Liu, ZM
Shoupe, D
Farquhar, C
Berek, JS
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA
[2] Cerner Hlth Insights, Beverly Hills, CA USA
[3] Univ So Calif, Sch Med, Los Angeles, CA USA
[4] Univ Auckland, Sch Med, Auckland, New Zealand
关键词
D O I
10.1097/01.AOG.0000167394.38215.56
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease. The optimal age for this recommendation in women at average risk for ovarian cancer has not been determined. Methods: Using published age-specific data for absolute and relative risk, both with and without oophorectomy, for ovarian cancer, coronary heart disease, hip fracture, breast cancer, and stroke, a Markov decision analysis model was used to estimate the optimal strategy for maximizing survival for women at average risk of ovarian cancer. For each 5-year age group from 40 to 80 years, 4 strategies were compared: ovarian conservation or oophorectomy, and use of estrogen therapy or nonuse. Outcomes, as proportion of women alive at age 80 years, were measured. Sensitivity analyses were performed, varying both relative and absolute risk estimates across the range of reported values. Results: Ovarian conservation until age 65 benefits long-term survival for women undergoing hysterectomy for benign disease. Women with oophorectomy before age 55 have 8.58% excess mortality by age 80, and those with oophorectomy before age 59 have 3.92% excess mortality. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%. These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary heart disease. Conclusion: Ovarian conservation until at least age 65 benefits long-term survival for women at average risk of ovarian cancer when undergoing hysterectomy for benign disease.
引用
收藏
页码:219 / 226
页数:8
相关论文
共 46 条
[1]  
*ACOG, 1999, ACOG PRACT B, V7
[2]  
*AG HELATHCARE RES, 2005, NAT IMP SAMPL HCUP D
[3]   Effects of conjugated, equine estrogen in postmenopausal women with hysterectomy - The women's health initiative randomized controlled trial [J].
Anderson, GL ;
Limacher, M ;
Assaf, AR ;
Bassford, T ;
Beresford, SAA ;
Black, H ;
Bonds, D ;
Brunner, R ;
Brzyski, R ;
Caan, B ;
Chlebowski, R ;
Curb, D ;
Gass, M ;
Hays, J ;
Heiss, G ;
Hendrix, S ;
Howard, BV ;
Hsia, J ;
Hubbell, A ;
Jackson, R ;
Johnson, KC ;
Judd, H ;
Kotchen, JM ;
Kuller, L ;
LaCroix, AZ ;
Lane, D ;
Langer, RD ;
Lasser, N ;
Lewis, CE ;
Manson, J ;
Margolis, K ;
Ockene, J ;
O'Sullivan, MJ ;
Phillips, L ;
Prentice, RL ;
Ritenbaugh, C ;
Robbins, J ;
Rossouw, JE ;
Sarto, G ;
Stefanick, ML ;
Van Horn, L ;
Wactawski-Wende, J ;
Wallace, R ;
Wassertheil-Smoller, S .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (14) :1701-1712
[4]  
Arias Elizabeth, 2003, Natl Vital Stat Rep, V52, P1
[5]   Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations:: A decision analysis [J].
Armstrong, K ;
Schwartz, JS ;
Randall, T ;
Rubin, SC ;
Weber, B .
JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (06) :1045-1054
[6]   Women awaiting hysterectomy: a qualitative study of issues involved in decisions about oophorectomy [J].
Bhavnani, V ;
Clarke, A .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2003, 110 (02) :168-174
[7]   Hormone therapy prescribing patterns in the United States [J].
Buist, DSM ;
Newton, KM ;
Miglioretti, DL ;
Beverly, K ;
Connelly, MT ;
Andrade, S ;
Hartsfield, CL ;
Wei, FF ;
Chan, KA ;
Kessler, L .
OBSTETRICS AND GYNECOLOGY, 2004, 104 (05) :1042-1050
[8]  
*CDC NCHS, 2003, TABL HIST002R 2 DEAT
[9]  
*CDC NCHS NAT VIT, 1998, TABL HIST002R 2 DEAT, P408
[10]   Mortality after all major types of osteoporotic fracture in men and women: an observational study [J].
Center, JR ;
Nguyen, TV ;
Schneider, D ;
Sambrook, PN ;
Eisman, JA .
LANCET, 1999, 353 (9156) :878-882