TY - JOUR
T1 - Effect of risk-reducing salpingo-oophorectomy on sex steroid hormone serum levels among postmenopausal women
T2 - an NRG Oncology/Gynecologic Oncology Group study
AU - Mai, Phuong L.
AU - Miller, Austin
AU - Black, Amanda
AU - Falk, Roni T.
AU - Boggess, John F.
AU - Tucker, Katherine
AU - Stuckey, Ashley R.
AU - Rodriguez, Gustavo C.
AU - Wong, Cheung
AU - Amatruda, Thomas T.
AU - Wilkinson, Kelly J.
AU - Modesitt, Susan C.
AU - Yamada, S. Diane
AU - Bixel, Kristin L.
AU - Glaser, Gretchen E.
AU - Rose, Peter G.
AU - Greene, Mark H.
AU - Sherman, Mark E.
N1 - Funding Information:
This study was supported by NIH grants to the NRG Oncology (grant number 1 U10 CA180822), the NRG Operations (grant number U10CA180868), and the National Cancer Institute Community Oncology Research Program (grant number UG1CA189867).The following NRG and Gynecologic Oncology Group member institutions participated in this study: The University of North Carolina at Chapel Hill; Australia New Zealand Gynaecological Oncology Group; Women and Infants Hospital; Evanston Community Clinical Oncology Program (CCOP)-NorthShore University Health System; Gynecologic Oncology Network/Brody School of Medicine; Fletcher Allen Health Care; Metro-Minnesota CCOP; University of Mississippi Medical Center; University of Virginia; University of Chicago; Ohio State University Comprehensive Cancer Center; Mayo Clinic; Case Western Reserve University; Walter Reed National Military Medical Center; University of California at Los Angeles Health System; Memorial Sloan-Kettering Cancer Center; Moffitt Cancer Center and Research Institute; Yale University; Washington University School of Medicine; University of Oklahoma Health Sciences Center; Delaware/Christiana Care CCOP; University of California Medical Center at Irvine - Orange Campus; MD Anderson Cancer Center; Wisconsin National Cancer Institute (NCI) Community Oncology Research Program; University of Minnesota Medical Center - Fairview; Tufts-New England Medical Center; University of New Mexico; Fox Chase Cancer Center; University of Massachusetts Memorial Health Care; Tacoma General Hospital; The Hospital of Central Connecticut; Carle Cancer Center; Cancer Research Consortium of West Michigan NCI Community Oncology Research Program; Virginia Commonwealth University; Roswell Park Comprehensive Cancer Center; Duke University Medical Center; Wayne State University/Karmanos Cancer Institute; University of Colorado Cancer Center - Anschutz Cancer Pavilion; University of Cincinnati; University of Iowa Hospitals and Clinics; The University of Texas Southwestern Medical Center; Indiana University Hospital/Melvin and Bren Simon Cancer Center; Rush University Medical Center; Cleveland Clinic Foundation; Ellis Fischer Cancer Center; Mark O Hatfield - Warren Grant Magnuson Clinical Center; Scott and White Memorial Hospital; Missouri Cancer Consortium CCOP; Northern Indiana Cancer Research Consortium; and Upstate Carolina CCOP.
Funding Information:
This study was supported by NIH grants to the NRG Oncology (grant number 1 U10 CA180822), the NRG Operations (grant number U10CA180868), and the National Cancer Institute Community Oncology Research Program (grant number UG1CA189867).
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Risk-reducing salpingo-oophorectomy is an effective ovarian cancer risk reduction strategy. However, bilateral oophorectomy has also been associated with increased long-term nonneoplastic sequelae, effects suggested to be mediated through reductions in systemic sex steroid hormone levels. Currently, it is unclear whether the postmenopausal ovary contributes to the systemic hormonal milieu or whether postmenopausal ovarian volume or other factors, such as body mass index and age, affect systemic hormone levels. Objective: We examined the impact of oophorectomy on sex steroid hormone levels in postmenopausal women. Furthermore, we explored how well ovarian volume measured by transvaginal ultrasound correlated with direct ovarian measures obtained during surgical pathology evaluation and investigated the association between hormone levels and ovarian volumes. Study Design: Postmenopausal women who underwent risk-reducing salpingo-oophorectomy (180 cases) or ovarian cancer screening (38 controls) enrolled in an international, prospective study of risk-reducing salpingo-oophorectomy and risk of ovarian cancer algorithm–based screening among women at increased risk of ovarian cancer (Gynecologic Oncology Group-0199) were included in this analysis. Controls were frequency matched to the cases on age at menopause, age at study entry, and time interval between blood draws. Ovarian volume was calculated using measurements obtained from transvaginal ultrasound in both cases and controls and measurements recorded in surgical pathology reports from cases. Serum hormone levels of testosterone, androstenedione, androstenediol, dihydrotestosterone, androsterone, dehydroepiandrosterone, estrone, estradiol, and sex hormone–binding globulin were measured at baseline and follow-up. Spearman correlation coefficients were used to compare ovarian volumes as measured on transvaginal ultrasound and pathology examinations. Correlations between ovarian volumes by transvaginal ultrasound and measured hormone levels were examined using linear regression models. All models were adjusted for age. Paired t tests were performed to evaluate individual differences in hormone levels before and after risk-reducing salpingo-oophorectomy. Results: Ovarian volumes measured by transvaginal ultrasound were only moderately correlated with those reported on pathology reports (Spearman rho [ρ]=0.42). The median time interval between risk-reducing salpingo-oophorectomy and follow-up for the cases was 13.3 months (range, 6.0–19.3), and the median time interval between baseline and follow-up for the controls was 12.7 months (range, 8.7–13.4). Sex steroid levels decreased with age but were not correlated with transvaginal ultrasound ovarian volume, body mass index, or time since menopause. Estradiol levels were significantly lower after risk-reducing salpingo-oophorectomy (percentage change, −61.9 post-risk-reducing salpingo-oophorectomy vs +15.2 in controls; P=.02), but no significant differences were seen for the other hormones. Conclusion: Ovarian volumes measured by transvaginal ultrasound were moderately correlated with volumes directly measured on pathology specimens and were not correlated with sex steroid hormone levels in postmenopausal women. Estradiol was the only hormone that declined significantly after risk-reducing salpingo-oophorectomy. Thus, it remains unclear whether the limited post–risk-reducing salpingo-oophorectomy changes in sex steroid hormones among postmenopausal women impact long-term adverse outcomes.
AB - Background: Risk-reducing salpingo-oophorectomy is an effective ovarian cancer risk reduction strategy. However, bilateral oophorectomy has also been associated with increased long-term nonneoplastic sequelae, effects suggested to be mediated through reductions in systemic sex steroid hormone levels. Currently, it is unclear whether the postmenopausal ovary contributes to the systemic hormonal milieu or whether postmenopausal ovarian volume or other factors, such as body mass index and age, affect systemic hormone levels. Objective: We examined the impact of oophorectomy on sex steroid hormone levels in postmenopausal women. Furthermore, we explored how well ovarian volume measured by transvaginal ultrasound correlated with direct ovarian measures obtained during surgical pathology evaluation and investigated the association between hormone levels and ovarian volumes. Study Design: Postmenopausal women who underwent risk-reducing salpingo-oophorectomy (180 cases) or ovarian cancer screening (38 controls) enrolled in an international, prospective study of risk-reducing salpingo-oophorectomy and risk of ovarian cancer algorithm–based screening among women at increased risk of ovarian cancer (Gynecologic Oncology Group-0199) were included in this analysis. Controls were frequency matched to the cases on age at menopause, age at study entry, and time interval between blood draws. Ovarian volume was calculated using measurements obtained from transvaginal ultrasound in both cases and controls and measurements recorded in surgical pathology reports from cases. Serum hormone levels of testosterone, androstenedione, androstenediol, dihydrotestosterone, androsterone, dehydroepiandrosterone, estrone, estradiol, and sex hormone–binding globulin were measured at baseline and follow-up. Spearman correlation coefficients were used to compare ovarian volumes as measured on transvaginal ultrasound and pathology examinations. Correlations between ovarian volumes by transvaginal ultrasound and measured hormone levels were examined using linear regression models. All models were adjusted for age. Paired t tests were performed to evaluate individual differences in hormone levels before and after risk-reducing salpingo-oophorectomy. Results: Ovarian volumes measured by transvaginal ultrasound were only moderately correlated with those reported on pathology reports (Spearman rho [ρ]=0.42). The median time interval between risk-reducing salpingo-oophorectomy and follow-up for the cases was 13.3 months (range, 6.0–19.3), and the median time interval between baseline and follow-up for the controls was 12.7 months (range, 8.7–13.4). Sex steroid levels decreased with age but were not correlated with transvaginal ultrasound ovarian volume, body mass index, or time since menopause. Estradiol levels were significantly lower after risk-reducing salpingo-oophorectomy (percentage change, −61.9 post-risk-reducing salpingo-oophorectomy vs +15.2 in controls; P=.02), but no significant differences were seen for the other hormones. Conclusion: Ovarian volumes measured by transvaginal ultrasound were moderately correlated with volumes directly measured on pathology specimens and were not correlated with sex steroid hormone levels in postmenopausal women. Estradiol was the only hormone that declined significantly after risk-reducing salpingo-oophorectomy. Thus, it remains unclear whether the limited post–risk-reducing salpingo-oophorectomy changes in sex steroid hormones among postmenopausal women impact long-term adverse outcomes.
KW - ovarian volume
KW - postmenopausal sex steroid hormones
KW - risk-reducing salpingo-oophorectomy
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UR - http://www.scopus.com/inward/citedby.url?scp=85127602792&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2022.02.022
DO - 10.1016/j.ajog.2022.02.022
M3 - Article
C2 - 35216968
AN - SCOPUS:85127602792
VL - 227
SP - 61.e1-61.e18
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
SN - 0002-9378
IS - 1
ER -