Tubal Ligation May Limit Spread Of Endometrial Cancer

MedicalResearch.com Interview with:
Ashley S. Felix, PhD

Bethesda, MD

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Felix: Endometrial cancer prognosis is strongly affected by disease stage, or the extent of spread from the primary site. Endometrial cancers can spread via the lymph nodes, blood vessels, through the uterine wall, or through the fallopian tube into the peritoneal cavity. The last of these mechanisms is poorly understood, but appears to be a more common mode of spread for aggressive histologic subtypes of endometrial cancer. We hypothesized that women who previously underwent tubal ligation (TL) and later developed endometrial cancer would have lower stage disease, possibly by blocking passage of tumor cells along the fallopian tubes. Further, we hypothesized that TL would be associated with better prognosis, due to its relationship with lower stage.

We found that women in our study who previously had tubal ligation were more likely to have lower stage endometrial cancer compared with women who did not report a previous tubal ligation. Specifically, tubal ligation was inversely associated with stage III and stage IV cancer across all subtypes of the disease, including aggressive histologic subtypes. Further, in statistical models of tubal ligation, tumor stage, and mortality, we observed no independent association with improved survival, suggesting that tubal ligation impacts mortality mainly through its effects on stage.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Felix: Our results further support the role of the fallopian tubes in advancing tumor spread, and suggest the evaluation of the tubes for evidence of tumor spread, especially for aggressive histologic subtypes more likely to spread along this route. Consequently, clinicians treating aggressive endometrial tumors may consider evaluating the fallopian tubes for evidence of spread.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Felix: Our study provides indirect support that passage of endometrial cancer cells along the fallopian tubes may be a clinically relevant route of metastasis. However, future research should examine the relationship between presence of intraluminal tumor cells and prognosis, especially among women with aggressive endometrial carcinoma subtypes.

Citation:

Relationships of Tubal Ligation to Endometrial Carcinoma Stage and Mortality in the NRG Oncology/ Gynecologic Oncology Group 210 Trial

Ashley S. Felix, Louise A. Brinton, D. Scott McMeekin, William T. Creasman, David Mutch, David E. Cohn, Joan L. Walker, Richard G. Moore, Levi S. Downs, Robert A. Soslow, Richard Zaino, and Mark E. Sherman

JNCI J Natl Cancer Inst (2015) 107 (9): djv158 doi:10.1093/jnci/djv158

Ashley S. Felix, PhD, & Bethesda, MD (2015). Tubal Ligation May Limit Spread Of Endometrial Cancer MedicalResearch.com