Relationship Between Pelvic Inflammatory Diseases And The Risk Of Ovarian Tumors:A Meta Analysis

Objective:Pelvic inflammatory disease is a common infectious disease in the upper reproductive tract of women,which can cause chronic pelvic pain,recurrent inflammation,tubal pregnancy and infertility,etc,and its long-term complications and adverse sequelae have attracted much attention in clinic.however,there are few and inconsistent studies on the relationship between pelvic inflammation and the risk of ovarian tumors.this paper mainly collects articles about the relationship between pelvic inflammation and ovarian tumors.The purpose of this study is to analyze and evaluate the correlation between pelvic inflammatory disease and the risk of ovarian tumors by meta,so as to provide evidence-based medical evidence for the causal relationship between pelvic inflammatory disease and ovarian tumors,and then provide evidence for clinical primary prevention.Methods:English databases(PubMed,Web of science,Embase,Cochrane Library)and Chinese databases[China knowledge Network database(CNKI),Wanfang database and Chinese biomedical literature database(CBM)],were searched by computer to search the articles about the correlation between pelvic inflammatory disease and ovarian tumor risk published in December 2019,and the literatures were screened according to the inclusion and exclusion criteria by EndNote X9.The quality of the included literature was evaluated by using the quality evaluation form Newcastle-Ottawa Scale(NOS scale)of non-randomized controlled clinical trials,and the software Rev Man5.3 was used to process the data and complete the Meta analysis of the included literature.Results:A total of 14 articles were in accordance with the analysis criteria,including 6cohort studies and 8 case-control studies.The results were as follows:pelvic inflammation was associated with the overall increased risk of ovarian tumors[OR=1.14,95%CI=1.04~1.24,I~2=43%,Z=2.90(P=0.004)].Further analysis was made by race,type of study,number of pelvic inflammatory disease,histological type of ovarian tumor and pelvic inflammatory disease women who took contraceptive orally,there was a positive correlation between pelvic inflammation and the risk of ovarian tumor in yellow population[OR=1.72,95%CI=1.25~2.37,Z=3.34(P=0.0008)],slightly significant was observed in Caucasians[OR=1.08,95%CI=0.98~1.19,Z=1.63(P=0.1)],but not statistically significant.The estimated risk of ovarian tumors increased in both the cohort study[OR=1.22,95%CI=1.02~1.45,Z=2.24(P=0.03)]and the case-control study[OR=1.13,95%CI=0.90~1.42,Z=1.04(P=0.30)],but there was no statistical significance in the case-control study.There was no significant difference in the risk of ovarian tumors between patients with primary pelvic inflammation and ovarian tumors[OR=3.58,95%CI=0.33~38.51,Z=1.05(P=0.29)],there was a significant difference between patients with more than 2 pelvic inflammatory diseases and the risk of ovarian tumors[OR=10.02,95%CI=3.66~27.42,Z=4.48(P=0.00001)],therefore,patients with≥2pelvic inflammatory diseases were positively correlated with the risk of ovarian tumors.There was a significant difference in the risk of pelvic inflammation and ovarian serous tumor[OR=1.30,95%CI=1.04~1.64,Z=2.29(P=0.02)],there was a significant difference in the risk of pelvic inflammation and non-serous epithelial tumors of the ovary[OR=0.83,95%CI=0.70~0.99,Z=2.03(P=0.04)],therefore,patients with pelvic inflammation are positively correlated with the risk of ovarian serous tumors,while patients with pelvic inflammation are negatively correlated with the risk of non-serous ovarian tumors.PID patients who did not take contraceptive orally were significantly associated with the risk of ovarian tumors[OR=1.68,95%CI=1.23~2.29,Z=3.27(P=0.001)],therefore,in the non-oral contraceptive population,PID patients are positively correlated with the risk of ovarian tumors,there was a significant correlation between PID patients taking contraceptive and the risk of ovarian tumors[OR=1.58,95%CI=1.15~2.17,Z=2.82(P=0.005)],therefore,in people who took contraceptive orally,PID patients were positively correlated with the risk of ovarian tumors,but in the PID population,there was no statistical significance between oral contraceptive and the risk of ovarian tumor[OR=1.23,95%CI=0.49~3.07,Z=0.44(P=0.66)].Conclusion:Our results suggest that pelvic inflammation is associated with the overall increased risk of ovarian tumors,and pelvic inflammation may be a potential risk factor for ovarian tumors.In further meta-analysis,the risk of ovarian tumor in patients with pelvic inflammatory disease is higher in the yellow population,women with more than 2 times of pelvic inflammation are more likely to develop ovarian tumors,and patients with pelvic inflammation have a higher risk of serous ovarian tumors.Despite the above conclusions,we need to use objective evaluation methods(such as hospital records,etc.)to conduct large-scale,carefully designed studies to confirm the results of the Meta analysis.