| 1. |
- Collins, Elin, 1981-
(författare)
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Benign hysterectomy and salpingectomy : outcomes and complications according to Swedish health and quality registers and women’s perspectives
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Opportunistic salpingectomy at the time of hysterectomy, i.e., removing presumed healthy fallopian tubes when removing the uterus, is suggested to reduce the risk of ovarian cancer. However, the impact of opportunistic salpingectomy on complications and ovarian function is insufficiently studied. Furthermore, the perspectives of women with no increased risk of ovarian cancer facing the choice to undergo opportunistic salpingectomy at hysterectomy have not been previously explored. There is consensus that surgical complications are important to register, both for quality control and research. Nevertheless, internationally there is no agreement on when, how, and even what to register, which reduces the comparability. This thesis aimed to compare complication rates and menopausal symptoms after opportunistic salpingectomy, as well as to explore women’s views on hysterectomy and salpingectomy before surgery. Furthermore, it aimed to validate complication registration after uterine and adnexal surgery in the Swedish National Quality Register of Gynecological Surgery (GynOp).MethodsA retrospective cohort study with data from GynOp (Paper I), explored the uptake of opportunistic salpingectomy in Sweden 1998-2016. Hysterectomy with bilateral salpingectomy vs hysterectomy only, performed 2013-2016, was compared regarding complications and menopausal symptoms one year after surgery. Paper II is a qualitative study, with focus group discussions including women waiting for hysterectomy in different parts of Sweden. The participants’ experiences and perceptions of health, healthcare, and potential outcomes of hysterectomy with or without salpingectomy were explored. For Paper III, a cross-sectional study based on a survey sent to Swedish gynecologists was conducted. Fictional cases describing various postoperative courses were used to explore interrater reliability in assessing complications according to the methods in GynOp. Finally, a cohort study including surgeries of the uterus and/or adnexa with benign indications 2017-2020 was conducted. Complications registered in GynOp, the National Patient Register, Prescribed Drug Register, and Cause of Death Register were compared (Paper IV).ResultsThe uptake of bilateral salpingectomy at the time of hysterectomy increased from 1.9% in 2012 to 37.8% in 2016. Comparing hysterectomy with bilateral salpingectomy vs hysterectomy only, salpingectomy was associated with an increased risk of menopausal symptoms one year after surgery (adjusted relative risk (aRR) 1.35, 95% confidence interval (CI) 1.07-1.71)). A slight increase in mean length of hospital stay (0.1 day, 95% CI 0.01-0.17) was seen, as well as an increased risk of minor complications in unadjusted analysis (relative risk (RR) 1.36, 95% CI 1.05-1.77). The latter was, however, not significant after adjusting for potential confounders (aRR 1.29, 95% CI 0.92-1.82) (Paper I). Women waiting for hysterectomy expressed that healthcare personnel held differing perspectives from the women, both regarding the surgery and the health problems being the cause of surgery. They also perceived a dependency on the advice and opinion of the physician for the choice of surgical procedure and possibly having opportunistic salpingectomy (Paper II). Swedish gynecologists demonstrated high interrater reliability in assessing whether a complication had occurred (agreement >80% in 85% of cases (17/20)), and in using the Clavien-Dindo classification, (agreement >90% in 80% of cases (16/20)) in our survey. Cases with lower agreement rates were bordering between minor complications and normal postoperative course (Paper III). From 2017 to 2020, 32,537 surgeries of the uterus and/or adnexa were registered in GynOp (Paper IV). Higher rates of complications from discharge to three months were found in GynOp compared with the Patient Register (13.7% vs 6.9%). The coverage of all complications was 79.1% in GynOp and 46.1% in the Patient Register when linking the two registers. Of the included individuals, 12.7% had a prescription of antibiotics ≤30 days after surgery, indicating a postoperative infection.ConclusionsThis thesis suggests that bilateral salpingectomy at the time of hysterectomy affects ovarian function and might increase the risk of minor complications, concerns which must be properly addressed in the consultation before surgery as well as in future research. Research on surgical interventions require reliable tools for evaluating complications. In finding a higher rate of complications captured in GynOp compared with the health registers, and a high interrater reliability among Swedish gynecologists, the registration of complications in GynOp are validated. However, continued work is required with definitions of what is normal in recovery after any specific surgery, for reliable capture of complications and to provide adequate information before surgery. Shared decision-making based on high quality scientific evidence of risks and benefits is important in all interventions, especially in prophylactic surgery, e.g., opportunistic salpingectomy.
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| 2. |
- Strandell, Annika, et al.
(författare)
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Evidensbaserad gynekologi
- 2022. - 3
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Ingår i: Gynekologi. - Lund : Studentlitteratur AB. - 9789144144191 ; , s. 109-123
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Idahl, Annika, 1965-
(författare)
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Chlamydia trachomatis as a risk factor for infertility in women and men, and ovarian tumor development
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Chlamydia trachomatis in women is a risk factor for tubal factor infertility and extra uterine pregnancies, but the impact of a C. trachomatis infection on male fertility is unclear. It is also hypothesized that persistent infection with C. trachomatis, or other microorganisms, might initiate/promote ovarian tumor development. The aims of the thesis were to study whether C. trachomatis serum antibodies in women and men had an impact on infertility diagnoses, semen characteristics, pregnancy rates and pregnancy outcomes; furthermore, to explore associations of C. trachomatis, and Mycoplasma genitalium, plasma antibodies with epithelial ovarian cancer and borderline ovarian tumors, as well as the presence of C. trachomatis bacteria, and other microorganisms, in ovarian tissues. Materials and methods: Papers I and II: 244/226 infertile couples were tested for serum C. trachomatis IgG, IgA, IgM and chlamydial Heat Shock Protein 60 (cHSP60) IgG antibodies. C. trachomatis IgG positive couples were also tested for C. trachomatis DNA in a urine sample. The follow-up period was 14-54 months. 244 spontaneously pregnant women were also tested for serum C. trachomatis IgG antibodies. Papers III and IV: Plasma samples from 291 women with epithelial ovarian cancer, borderline ovarian tumors and benign conditions, and plasma samples from 271 healthy controls, were analyzed for C. trachomatis IgG, IgA and cHSP60-1 IgG and M. genitalium IgG antibodies. Ovarian tissues from 186 women with benign ovaries, borderline ovarian tumors and epithelial ovarian cancer, as well as tissues from the contra lateral ovary in 126 women, were analyzed for the presence of C. trachomatis, M. genitalium, Neisseria gonorrhoeae, HPV and the polyoma viruses BKV and JCV with nucleic acid amplification tests. Results: Papers I and II: The prevalence of C. trachomatis IgG antibodies was higher among infertile than fertile women, and there were 9 couples with ongoing C. trachomatis infections. In men, C. trachomatis IgG and IgA antibodies were associated with a reduced likelihood to achieve pregnancy for the couple, as well as lower sperm concentration, reduced sperm motility and vitality, increased teratozoospermia index and the occurrence of leukocytes. C. trachomatis IgG and cHSP60 IgG antibodies in infertile women were associated with tubal factor infertility, but not with reduced pregnancy rates or outcomes. Paper III: cHSP60-1 IgG antibodies were associated with ovarian cancer belonging to the postulated type II pathogenetic pathway when plasma samples obtained more than one year prior to diagnosis were analyzed. M. genitalium IgG antibodies were associated with borderline ovarian tumors; however a statistical type 1 error cannot be excluded. Paper IV: None of the microorganisms studied were found in the ovarian tissue samples. Conclusions: C. trachomatis IgG and IgA antibodies in the man substantially decreases the chances of the infertile couple to achieve pregnancy, and are associated with subtle negative changes in semen characteristics. C. trachomatis IgG and cHSP60 IgG antibodies in the woman are risk factors for tubal factor infertility. Prospective plasma cHSP60-1 IgG antibodies are associated with type II ovarian carcinomas, but C. trachomatis bacteria, or the other microorganisms studied, could not be detected in benign, borderline or malignant ovarian tissues.
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| 4. |
- Idahl, Annika, 1965-, et al.
(författare)
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Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus, and polyomavirus are not detectable in human tissue with epithelial ovarian cancer, borderline tumor, or benign conditions
- 2010
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 202:1, s. 71.e1-71.e6
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: We sought to analyze the presence of the microorganisms Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus (HPV), and the polyomaviruses BK virus (BKV) and JC virus (JCV) in ovarian tissues of women with ovarian carcinomas, borderline tumors, and benign conditions. STUDY DESIGN: Ovarian tissue, snap-frozen and stored at -80 degrees C, from 186 women with benign conditions, borderline tumors, and epithelial ovarian cancer, as well as tissue from the contralateral ovary of 126 of these women, were analyzed regarding presence of C trachomatis and N gonorrhoeae (transcription mediated amplification), M genitalium (real-time polymerase chain reaction [PCR]), HPV (PCR), and BKV and JCV (PCR). RESULTS: All the tissue samples studied were found negative for the microorganisms analyzed. CONCLUSION: C trachomatis, M genitalium, N gonorrhoeae, HPV, and the polyomaviruses BKV and JCV are not detectable in ovarian tissues either from women with benign conditions and borderline tumors or from women with ovarian cancer.
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| 5. |
- Idahl, Annika, 1965-, et al.
(författare)
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Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : results from the EPIC cohort
- 2019
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Ingår i: International Journal of Gynecological Cancer. - : BMJ Publishing Group Ltd. - 1048-891X .- 1525-1438. ; 29, s. A473-A474
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction/Background Sexually transmitted infections (STI) and pelvic inflammatory disease may cause damage to the fallopian tube where a substantial proportion of epithelial ovarian cancer (EOC) likely arises. The aim of this study was to determine whether Chlamydia trachomatis antibodies are associated with higher EOC risk. As secondary objectives, we investigated Mycoplasma genitalium,herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) 16, 18 and 45 and EOC risk.Methodology In a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort,791 cases and 1,669 matched controls with pre-diagnosis blood samples were analyzed. Cases and controls were matched on study center, and at blood collection age, time of day, fasting status, exogenous hormone use, menopausal status, and menstrual cycle phase. Antibodies against C. trachomatis, M. genitalium, HSV-2, and HPV 16, 18 and 45 (E6, E7, L1) were assessed using multiplex fluorescent bead-based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals [CI] comparing women with positive vs. negative serology.Results A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but was associated with higher risk of the mucinous histotype (RR=2.56 [95% CI=1.3–5.05]). Positive serology for chlamydia heat shock protein 60 (cHSP60-1), produced during persistent infection, was associated with higher risk of EOC overall (1.33 [1.09–1.62]) and of the serous subtype (1.42 [1.09–1.84]). None of the other evaluated STIs were associated with EOC risk overall; in analyses by histotype, HSV-2 was associated with higher risk of endometrioid EOC (2.93 [1.50–5.74]).Conclusion C. trachomatis infection may influence carcinogenesis of serous and mucinous EOC, while HSV-2 might promote endometrioid disease. Mechanisms linking STIs to EOC need to be further elucidated.
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| 6. |
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| 7. |
- Jonsson, Sarah, 1982-
(författare)
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Pelvic inflammatory disease and epithelial ovarian tumors
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Epithelial ovarian cancer and borderline ovarian tumors consist of several histotypes in which high-grade serous carcinoma is the most common. The majority of epithelial ovarian tumors are considered to originate in the fimbriated end of the fallopian tubes. What initiates these tumors is far from completely understood. Pelvic inflammatory disease has been proposed as a modifiable risk factor for epithelial ovarian tumors. A major cause of pelvic inflammatory disease is Chlamydia trachomatis which has been shown to have cancer-causing potential. The overall purpose of this thesis was to study associations of pelvic inflammatory disease and C. trachomatis with risk of epithelial ovarian tumors.Methods: In a cross-sectional study (Paper I) we collected ovarian tissue and corresponding blood samples from 69 women undergoing surgery due to suspected ovarian pathology. C. trachomatis specific protein (immunohistochemistry) and C. trachomatis DNA (qPCR) in ovarian tissue were analyzed (Paper I). In a nested case-control study (Paper II) prospective blood samples from 92 women diagnosed with high-grade serous ovarian cancer were matched to four controls each for age and date of plasma sampling. C. trachomatis specific plasma antibodies were analyzed by commercial Enzyme-Linked ImmunoSorbent Assay (ELISA) and Micro-ImmunoFluorescence (MIF) (Paper I and Paper II). We performed a nationwide register-based case-control study where we included 15 072 women diagnosed with epithelial ovarian cancer (Paper III), 4782 women diagnosed with borderline ovarian tumors (Paper IV), and ten controls each matched for age and residential district. Using national Swedish registers, we retrieved data on historyof pelvic inflammatory disease and the potential confounding factors parity, educational level, previous gynecological surgery, and hormonal therapy.Results: We found C. trachomatis DNA in ovarian tissue of eight women with ovarian carcinoma, but not in ovarian tissue from women with borderline ovarian tumors or benign disease (Paper I). The prevalence of the C. trachomatis specific protein did not differ in benign and malignant tissue (Paper I). Prevalence of C. trachomatis specific plasma antibodies was similar in cases and controls at diagnosis (Paper I) and prospectively (Paper II). A history of clinically verified pelvic inflammatory disease was associated with an increased risk of epithelial ovarian cancer overall (Paper III) and borderline ovarian tumors overall (Paper IV). Histotype-specific analyses showed an increased risk of serous carcinoma (Paper III), high-grade serous carcinoma (Paper III), clear cell carcinoma (Paper III), and serous borderline ovarian tumors (Paper IV) but not significantly with other histotypes. A dose-response relationship was seen between an increased number of pelvic inflammatory disease episodes and epithelial ovarian cancer (Paper III), as well as borderline ovarian tumors (Paper IV).Conclusions: This thesis contributes to an improved understanding of the association between pelvic inflammatory disease and epithelial ovarian tumors. The results regarding C. trachomatis are inconclusive and suggests that the association of pelvic inflammatory disease with epithelial ovarian tumors acts through mechanisms other than Chlamydia alone.
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| 8. |
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| 9. |
- Schock, Helena, 1984-
(författare)
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Hormone concentrations during pregnancy and maternal risk of epithelial ovarian cancer
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The aim of this thesis was to study the relationship of pre-diagnostic circulating concentrations of sex steroid hormones (androgens, estradiol, 17-hydroxyprogesterone, and progesterone), growth factors (insulin-like growth factor-I (IGF-I), placental growth hormone (GH)), sex hormone binding globulin (SHBG), and anti-Müllerian hormone (AMH) with risk of epithelial ovarian cancer (EOC) overall, and by tumor invasiveness and histology. A longitudinal study was used to assess patterns of hormonal changes during a single pregnancy, and in two consecutive pregnancies.Materials & Methods: A case-control study was nested within the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort. A total of 1 052 EOC cases were identified through linkages with the cancer registries in both countries. For each case, 2-3 controls were selected. Cases and controls were matched on cohort, age and date at blood draw, as well as for parity at blood draw and at diagnosis (n=2 695). Odds ratios (OR) and corresponding 95% confidence intervals [CI] were estimated using conditional logistic regression. The longitudinal study was based on 71 pregnant Finnish women, who donated blood samples in each trimester of pregnancy.Results: Higher androgen concentrations were associated with an increased risk of overall EOC (e.g., testosterone ORT3 vs. T1: 1.56 [1.30-1.87], ptrend<0.0001), while the risk of endometrioid tumors increased with higher estradiol concentrations (ORT3 vs. T1: 2.76 [1.04-7.33], ptrend=0.03). Higher IGF-I was associated with a non-significant decrease in risk for invasive (ORT3 vs. T1: 0.79 [0.62-1.02], ptrend=0.07) and endometrioid tumors (ORT3 vs. T1: 0.55 [0.28-1.07], ptrend=0.07). The inverse association between IGF-I levels and risk of invasive EOC was stronger in analyses limited to women aged <55 years at diagnosis (ORT3 vs. T1: 0.74 [0.57-0.96], ptrend=0.03). No associations were observed between pre-diagnostic progesterone, SHBG, placental GH, and AMH with EOC risk overall, or by tumor invasiveness and histology.The longitudinal study showed that hormone concentrations were more strongly correlated between consecutive trimesters of a pregnancy than between the 1st and 3rd trimesters. Further, 3rd trimester hormone concentrations can be estimated from 1st or 2nd trimester measurements.Conclusion: Higher pre-diagnostic androgens, estradiol, and IGF-I are associated with EOC risk, and associations differ by tumor invasiveness and histology.
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| 10. |
- Schock, Helena, 1984-, et al.
(författare)
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Longitudinal Assessment of Pregnancy Hormones
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Evidence suggests that the hormonal milieu of pregnancy is an important determinant of subsequent cancer and other chronic diseases in both the mother and the offspring. How well a single blood specimen collected during a pregnancy characterizes exposure to these hormones throughout gestation, and also in subsequent pregnancies, is not well understood. We used serial serum samples from 71 pregnant women (25 primiparous, 25 biparous, and 21 with 2 consecutive pregnancies) with natural, complication-free pregnancies and a healthy offspring at term who participated in a population-based screening trial for congenital infections in Finland between January 1st, 1988 and June 30, 1989 and provided a blood sample in each trimester. Hormone levels were more strongly correlated between consecutive trimesters of a pregnancy than between the 1st and 3rd trimester (e.g. estradiol, 1st vs. 2nd and 2nd vs. 3rd trimester r=0.51 and r=0.60, p<0.01; 1st vs. 3rd trimester r=0.32, p<0.05). Concentrations of sRANKL remained stable throughout gestation, whereas estradiol, estrone, progesterone, testosterone, prolactin, and osteoprotegerin increased throughout pregnancy. First trimester hormone concentrations explained less of the variation in the third trimester on their own than second trimester hormone levels (e.g. estradiol R²T1=16% and R²T2=42%). Addition of maternal (e.g., smoking) and/or child characteristics (e.g., sex) improved the accuracy of the 3rd trimester estimates for some of the hormones. In conclusion, one hormone measurement in early pregnancy, in conjunction with maternal and fetal characteristics, permits estimation of 3rd trimester hormone concentrations.
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