Abstract
To investigate the association between endometriosis, tubal ligation, hysterectomy and epithelial ovarian cancer. Relevant published literatures were searched in PubMed, ProQuest, Web of Science and Medline databases during 1995–2016. Heterogeneity was evaluated by I2 statistic. Publication bias was tested by funnel plot and Egger’s test. Odds ratio and 95% CI were used to assess the association strength. The statistical analyses in this study were accomplished by STATA software package. A total of 40,609 cases of epithelial ovarian cancer and 368,452 controls in 38 publications were included. The result suggested that endometriosis was associated with an increased risk of epithelial ovarian cancer (OR = 1.42, 95% CI = 1.28–1.57), tubal ligation was associated with a decreased risk of epithelial ovarian cancer (OR = 0.70, 95% CI = 0.60–0.81), while hysterectomy show no relationship with epithelial ovarian cancer (OR = 0.97, 95% CI = 0.81–1.14). A stratified analysis showed there were associations between endometriosis and the increased risk of epithelial ovarian cancer for studies conducted in USA and Europe. Meanwhile, there were associations between tubal ligation and the decreased risk of epithelial ovarian cancer for studies conducted in USA, Asia, Europe and Australia. The result indicated that endometriosis was a risk factor of epithelial ovarian cancer whereas tubal ligation was a protective risk factor of epithelial ovarian cancer, hysterectomy may have no relationship with epithelial ovarian cancer.
Highlights
Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer death and the eighth most common cancer in women [1,2]
EOC; (3) the data of case and control numbers in different risk factors were presented in the publication or the data given were necessary to calculate these; (4) Odds ratio (OR) or OR with 95% confidence intervals (CIs) of each risk factor were presented in the publication or the data given were necessary to calculate these; (5) when the publications were from the same or overlapping data, we selected the most recent or largest population; (6) English was stipulated as the publication language; (7) reviews, letters or case reports were excluded
368,452Incontrols, we found that when endometriosis risk factor ovarian cancer whereas the sensitivity analysis, all studieswas wasaremoved oneofbyepithelial one and the rest were analyzed tubal ligation by wasmeta-analysis, a protective the riskpooled factor ORs of epithelial cancer, may had no sequentially were not ovarian materially alteredhysterectomy with the overall pooled relationship with epithelial ovarian cancer
Summary
Epithelial ovarian cancer (EOC) is the fifth leading cause of cancer death and the eighth most common cancer in women [1,2]. 1 in 70 women in the United States bear the pain of EOC, and the annual fatality rate of EOC cases is about 50% [3]. Clinical and epidemiologic studies have shown that the early detection technology of EOC is not yet perfect, and EOC is often diagnosed at advanced stage. Overall five-year survival rate of EOC is about 45% [4]. The exploration of risk factors is imperative for the reduction of the burden of disease. Certain modifiable risk factors have been reported to be related to EOC.
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