Chlamydia trachomatis infection and risk of ovarian cancer: a systematic review and meta-analysis.

Abstract

Chlamydia trachomatis infection has been implicated as a potential risk factor for ovarian cancer (OC), but evidence remains inconclusive. This study aims to assess the association between C. trachomatis infection and OC risk using a systematic review and meta-analysis. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and SciELO from their inception to October 2024. Observational studies examining the association between C. trachomatis infection and OC risk were included. Pooled odds ratios (ORs) were calculated using random-effects models. Subgroup and sensitivity analyses were performed based on diagnostic methods and control group types, and publication bias was assessed using Egger's test. Out of 3,288 records, 11 studies involving 4,518 participants were included. The overall meta-analysis revealed a non-significant association between C. trachomatis infection and OC risk (OR = 1.30, 95% CI = 0.99-1.70). However, sensitivity analysis excluding two studies demonstrated a significant association (OR = 1.37, 95% CI = 1.16-1.61). Subgroup analysis showed that PCR-diagnosed C. trachomatis infection was significantly associated with an increased risk (OR = 6.64, 95% CI = 1.62-25.71), while serology-based studies yielded non-significant results. Heterogeneity was high (I² = 70.83%), and publication bias was detected (Egger's test p = 0.015). These findings highlight the role of infection chronicity in OC pathogenesis and suggest that diagnostic methodology significantly impacts observed associations. Future research should employ longitudinal designs with serial molecular testing to establish temporality and evaluate whether targeted Chlamydia screening or treatment interventions could mitigate OC risk in high-prevalence populations.