Tubal ligation and survival of ovarian cancer patients


Dr Min Zhang, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. Email: min.zhang@uwa.edu.au


Aim:  The aim of the present study was to investigate associations between ovarian cancer survival and reproductive, gynecological and hormone factors.

Material and Methods:  A prospective follow-up study was conducted in the Southeast of China. The cohort comprised 202 patients with histopathologically confirmed epithelial ovarian cancer who were enrolled during 1999–2000 and followed-up for 5 years subsequently. One hundred and ninety five (96.5%) of the cohort or their close relatives were traced. Information was obtained on reproductive, gynecological and hormone factors prior to diagnosis, actual survival time and number of deaths. Cox proportional models were used to estimate mortality hazard ratios (HR) and associated 95% confidence intervals (CI) for tubal ligation, adjusting for age at diagnosis, body mass index (BMI), menopausal status, International Federation of Gynaecology and Obstetrics (FIGO) stage, histological grade of differentiation, cytology of ascites, and chemotherapy status.

Results:  The HR was significantly increased and survival was worse in ovarian cancer patients with a previous tubal ligation, but not with any other reproductive, gynecological and hormone factor. Only 21 (38.9%) of 54 patients who had tubal ligation survived to the time of interview, in contrast to 95 women (67.4%) still alive among the 141 women without tubal ligation (P < 0.001). Compared to the patients who had no tubal ligation, the adjusted HR was 1.62 (95% CI 1.01–2.59; P = 0.04) for those who had tubal ligation. There was no association with age at menarche, menopausal status, parity, breastfeeding, hormone replacement therapy, oral contraceptive use, and hysterectomy.

Conclusion:  Previous tubal ligation was an independently adverse prognostic factor for epithelial ovarian cancer survival. Further studies that examine the relationship are warranted to confirm these results.