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Sun M, Jiang W. Ovarian clear cell carcinoma with or without endometriosis origin in a single institution cohort. Discov Oncol 2023; 14:39. [PMID: 37004660 PMCID: PMC10067778 DOI: 10.1007/s12672-023-00649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/30/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND As ovarian clear cell carcinoma (OCCC) has distinct clinical features, biology, genetic characteristics and mechanisms of pathogenesis, and whether the origin of endometriosis or not affects the prognosis of OCCC remains controversial. METHODS We retrospectively collected medical records and follow-up data of patients with OCCC treated at the Obstetrics and Gynecology Hospital of Fudan University from January 2009 to December 2019. Further, we divided patients into 2 groups. Group 1: non-endometriosis origin; Group 2: endometriosis origin. Clinicopathological characteristics and survival outcomes were compared between the 2 groups. RESULTS A total of one hundred and twenty-five patients with ovarian clear cell carcinoma were identified and included. In the overall patients' population, the 5 year overall survival was 84.8%, the mean overall survival was 85.9 months. The results of the stratified analysis showed that early stage (FIGO stage I/II) OCCC had a good prognosis. The results of univariate analyses indicated that a statistically significant relationship between overall survival (OS) and FIGO stage, lymph node metastasis, peritoneum metastasis, chemotherapy administration methods, Chinese herbal treatment, molecular target therapy. As for progression-free survival (PFS), a significant relationship between PFS and child-bearing history, largest residual tumor size, FIGO stage, tumor maximum diameter, lymph node metastasis was found, respectively. FIGO stage and lymph node metastasis are common poor prognostic factors affecting OS and PFS. The multivariate regression analysis revealed that FIGO stage (p = 0.028; HR, 1.944; 95% CI 1.073-3.52) and treatment by Chinese herbs (p = 0.018; HR, 0.141; 95% CI 0.028-0.716) were identified as influencing factors with regard to survival. The presence or absence of lymphadenectomy did not affect OS of 125 OCCC patients (p = 0.851; HR, 0.825; 95% CI 0.111-6.153). There was a trend towards a better prognosis for patients with OCCC of endometriosis origin than those with OCCC of non-endometriosis origin (p = 0.062; HR, 0.432; 95% CI 0.179-1.045). The two groups differed with respect to several clinicopathological factors. And the proportion of patients with disease relapse was higher in Group 1 (46.9%) than in Group 2 (25.0%), with a statistically significant difference (p = 0.048). CONCLUSIONS Surgical staging and treatment by Chinese herbs postoperatively are two independent prognostic factors affecting the OS of OCCC, early detection and Chinese herbal medicine combined with chemotherapy postoperatively may be a good choice. Tumor with endometriosis-origin was found less likely to relapse. While the non-necessity of lymphadenectomy in advanced ovarian cancer has been proven, the need for lymphadenectomy in the early stage ovarian cancer, including early stage OCCC, still deserved to be explored.
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Affiliation(s)
- Mingming Sun
- Department Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
| | - Wei Jiang
- Department Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China.
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Tranoulis A, Buruiana FH, Gupta B, Kwong A, Lakhiani A, Yap J, Balega J, Singh K. Friend or foe? The prognostic role of endometriosis in women with clear cell ovarian carcinoma. A UK population-based cohort study. Arch Gynecol Obstet 2022; 305:1279-1289. [PMID: 34468823 DOI: 10.1007/s00404-021-06191-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The prognostic role of endometriosis amongst women with ovarian clear cell carcinoma (OCCC) remains debatable. The aim of this study was to ascertain the effect of endometriosis on the prognosis of OCCC. METHODS A retrospective review of the medical records of 94 women diagnosed and treated for OCCC at a tertiary gynaecological cancer centre in the UK, spanning the period 2010-2019. Women were divided into two groups according to the presence of endometriosis. Clinico-pathological characteristics, progression-free survival (PFS) and overall survival (OS) were collated between the two groups. RESULTS Forty-six cases of endometriosis-free OCCC (Ef-OCCC) were collated with 48 cases of endometriosis-related OCCC (Er-OCCC). There was no significant difference between the two groups regarding age (p-value = 0.2), FIGO stage (p-value = 0.8), residual disease (RD) (p-value = 0.07), adjuvant chemotherapy agent (p-value = 0.4) or chemo-resistance (p-value = 0.9). The presence of endometriosis did not significantly affect either OS or PFS. The median OS in the Ef-OCCC and Er-OCCC was 55.00 (95% CI 32.00-189.00) and 71.00 (95% CI 47.00-97.00; log rank = 1.35, p-value = 0.2) months. The median PFS in the Ef-OCCC and Er-OCCC group was 39.00 (95% CI 19.00-143.00) and 39.00 (95% CI 19.00-62.00; log rank = 0.7, p-value = 0.4) months. Survival differences between the two groups were not significant after stratification analysis for independent prognosticators. CONCLUSION Endometriosis was not independently associated with the prognosis of OCCC either in crude analysis or after stratification for stage and RD. Further larger, well-designed prospective studies are warranted to draw firmer conclusions on the intrinsic link between endometriosis and OCCC.
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Affiliation(s)
- Anastasios Tranoulis
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK.
| | - Felicia Helena Buruiana
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
| | - Bindiya Gupta
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
| | - Audrey Kwong
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
| | - Aarti Lakhiani
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
| | - Jason Yap
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Janos Balega
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
| | - Kavita Singh
- Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham, B18 7QH, UK
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Chou CY, Cheng WF, Chen MY, Lin H, Ho CM, Hung YC, Huang LW, Wang PH, Yu MH, Huang YF. Predicting Long-Term Prognoses and Grading Platinum Sensitivity Using a Novel Progression-Free Interval Criterion in Ovarian Clear Cell Carcinoma: A Multi-Institutional Cohort Study. Cancers (Basel) 2022; 14:1746. [PMID: 35406519 PMCID: PMC8997040 DOI: 10.3390/cancers14071746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 12/07/2022] Open
Abstract
This large-scale study aimed to determine the long-term influences of potential prognostic predictors and progression-free interval (PFI) criteria for grading platinum-sensitivity in ovarian clear cell carcinoma (OCCC). We retrospectively reviewed the medical records of OCCC patients presenting at nine tertiary centres (1995−2015), and evaluated patient characteristics, therapeutic factors, clinical outcomes, and hazard ratios for disease progression and death. We enrolled 536 patients (median follow-up, 36.6 months) and developed newly defined distributions of PFIs (seven and 14 months) for grading platinum sensitivity. In the multivariate model, preoperative CA125 levels and chemo-response independently predicted early-stage progression-free survival (PFS) risk. Post-progression cytoreduction correlated with reduced mortality risk. No unfavourable outcomes were observed with respect to coexisting endometriosis, fertility-sparing strategies, or platinum-based regimens. A PFI of <7 months, the strongest predictor of both post-progression mortality and second relapse risks, correlated with chemo-resistance, advanced tumour stage, and shortened post-progression survival. Chemotherapy regimens commonly used in front-line or relapse settings were limited in improving prognoses, especially in the advanced-stage cohort. Clinical trials of novel targeted agents and/or innovative biomarkers for chemoresistance should be comprehensively investigated and offered early to advanced-stage patients or those with OCCC progression occurring within seven months after receiving chemotherapy.
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Affiliation(s)
- Cheng-Yang Chou
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100226, Taiwan;
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chih-Ming Ho
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei 106, Taiwan;
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
| | - Yao-Ching Hung
- Department of Obstetrics and Gynecology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan;
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan;
| | - Po-Hui Wang
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Yu-Fang Huang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
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Li B, Wang Y, Wang Y, Li S, Liu K. Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome: A Rare Case Report and Review of Literature. Front Oncol 2022; 12:832228. [PMID: 35402227 PMCID: PMC8983876 DOI: 10.3389/fonc.2022.832228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMalignant transformation of deep infiltrating endometriosis (DIE) invading the cervix and rectum is quite rare, especially in patients combined with Lynch syndrome (LS). We report a rare case of a 49-year-old perimenopausal woman with endometrioid carcinoma arising from the pouch of Douglas, invading the cervix and rectum 1 year after a unilateral salpingo-oophorectomy treatment for ovarian endometriosis. The genetic testing of the patient showed germline mutations in MSH2, which combined with the special family history of colorectal cancer of the patient, was also thought to be associated with LS. We have analyzed the reported cases of DIE malignant transformation over the last 10 years, and reviewed the relevant literature, in order to strengthen the clinical management of patients with endometriosis, particularly patients with DIE, and reveal a possible correlation between malignant transformation of endometriosis and LS.Case PresentationA 49-year-old perimenopausal woman presented with hypogastralgia, diarrhea, and intermittent fever for more than 1 month. A Transvaginal ultrasound (TVS) showed a cervix isthmus mass, and a magnetic resonance imaging (MRI) showed a mass in pouch of Douglas with high suspicion of malignancy, possibly invading the anterior wall of the rectum. Prior to surgery, the patient performed the ultrasound guided pelvic mass biopsy through the vagina, and the pathology of the mass showed endometrioid carcinoma. The patient received a gynecological–surgical laparotomy and enterostomy, and a histopathology revealed endometrioid carcinoma infiltrating the cervical wall and rectal wall. In the family genetic history of the patient, her mother and two sisters suffered from colorectal cancer, so lesion tissue and blood were taken for genetic testing, which showed a germline mutation in MSH2, with LS being considered. After the surgical treatment, the patient received six courses of paclitaxel–carboplatin chemotherapy. During the course of treatment, bone marrow suppression occurred, but was healed after symptomatic treatment. To date, the patient is generally in good health, and imaging examination showed no evidence of recurrence.ConclusionThe risk of malignant transformation of endometriosis is increased in perimenopause and postmenopause, as DIE is a rare malignant transformation of endometriosis. DIE can invade other adjacent organs and cause poor prognosis, thus, comprehensive gynecological–surgical treatment should be necessary. In addition, if histopathology showed endometrioid carcinoma, the possibility of LS should be considered, and if necessary, immunohistochemical staining and gene detection should be improved to provide follow-up targeted therapy and immunotherapy.
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Vetvicka V, Fiala L, Garzon S, Buzzaccarini G, Terzic M, Laganà AS. Endometriosis and gynaecological cancers: molecular insights behind a complex machinery. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:201-206. [PMID: 35069072 PMCID: PMC8764963 DOI: 10.5114/pm.2021.111276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 12/11/2022]
Abstract
Endometriosis is described as the presence of both endometrial glandular and stromal cells outside the uterine cavity. A major characterization of this disease is ectopic implantation of endometrial cells with increased migration. It is one of the leading causes of morbidity among premenopausal women, with a prevalence of 10-16% of women of reproductive age. Despite over century of intensive research, none of the current treatment options represents a real cure. Based on the current knowledge, endometriosis, particularly its atypical version, is considered to be a transitional form from benign disease to tumour. However, the exact mechanisms of this conversion are still not fully established.
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Affiliation(s)
- Vaclav Vetvicka
- Department of Pathology, University of Louisville, Louisville, KY, United States
| | - Ludek Fiala
- Institute of Sexology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | | | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
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Eoh KJ, Han M, Kim EH, Jung I, Kim YT. Markedly increased risk of malignancies in women with endometriosis. Gynecol Oncol 2021; 161:291-296. [PMID: 33514482 DOI: 10.1016/j.ygyno.2021.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the cancer risk in a cohort of women with newly diagnosed endometriosis. METHODS This retrospective, nationwide, population-based cohort study utilized data from the 10-year claims database of the Korean National Health Insurance from January 2008 to December 2018. Patients diagnosed with endometriosis between 2010 and 2013 were included; those who underwent appendectomy but were not diagnosed with endometriosis during the study period served as controls. No participant was diagnosed with cancer before enrollment. Cancer diagnoses according to the International Classification of Diseases, 10th revision, were compared between the two groups. Cancer occurrence in both groups was identified according to the diagnostic codes for different organ sites. RESULTS Altogether, 179,865 patients with endometriosis and 87,408 controls were analyzed, and the incidence rates of cancer were 644.3 and 543.8 per 100,000 person-years, respectively. Patients with endometriosis had a significantly increased overall cancer risk (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.28-1.40; p < 0.001) than controls after adjusting for age, insurance type, and comorbidities. They had significantly increased uterine (HR, 4.59; 95% CI, 3.56-5.91; p < 0.001), ovarian (HR, 2.51; 95% CI, 1.99-3.16; p < 0.001), cervical (HR, 1.84; 95% CI, 1.49-2.28; p < 0.001), breast (HR, 1.44; 95% CI, 1.31-1.58; p < 0.001), and thyroid cancer (HR, 1.34; 95% CI, 1.24-1.45; p < 0.001) risk. Median age at diagnosis was <50 years for all cancer types. CONCLUSIONS Endometriosis was associated with an increased cancer risk, specifically uterine, ovarian, cervical, breast, and thyroid cancers, suggesting that effective cancer screening for early detection of malignancies in women should be implemented in those with endometriosis.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Young Tae Kim
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Endometriosis-associated Ovarian Cancer is a Subset With a More Favorable Outcome and Distinct Clinical-pathologic Characteristics. Int J Gynecol Pathol 2020; 38:435-442. [PMID: 30059454 DOI: 10.1097/pgp.0000000000000533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is a controversy about whether endometriosis-associated ovarian cancer (EAOC) might represent a different entity from the corresponding ovarian cancer occurring de novo, in the absence of endometriosis. This study investigated the clinical-pathologic characteristics and outcome of EAOC compared with other ovarian carcinomas that are not associated with endometriosis (non-EAOC) in a large cohort. Seven hundred two patients meeting the inclusion criteria were further subclassified as group I when patients had ovarian carcinoma associated with or arising within endometriosis (EAOC) and group II when patients had non-EAOC. Age, gross features, histologic type, International Federation of Gynecology and Obstetrics stage, and disease-free survival (DFS) were compared between the groups. One hundred sixty-eight (23.9%) patients had EAOC, whereas 534 (76.1%) patients had non-EAOC. EAOCs were mostly endometrioid and clear cell type. Patients with EAOC were younger, present early, and had a lower rate of recurrence when compared with patients with non-EAOC, P<0.001. Patients with EAOC had longer DFS time, 51.9 mo (95% confidence interval, 44.9-58.8) versus 30.5 mo (95% confidence interval, 27.7-33.3) in non-EAOC patients. The 5 yr Kaplan-Meier estimate of DFS rate was 70% in 166 patients of group I and was 39.3% in 532 patients of group II, P<0.001. On multivariate analysis, International Federation of Gynecology and Obstetrics staging, histologic type, and treatment were the only significant factors affecting the hazards of recurrence. Patients with tumors associated with endometriosis are usually, younger, present early, have lower rate of recurrence, longer DFS, and their tumors are of lower grade and are more likely endometrioid or clear cell carcinoma.
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Abstract
This review is an appraisal of the current state of knowledge of 2 enigmatic histotypes of ovarian carcinoma: endometrioid and clear cell carcinoma. Both show an association endometriosis and the hereditary nonpolyposis colorectal cancer (Lynch) syndrome, and both typically present at an early stage. Pathologic and immunohistochemical features that distinguish these tumors from high-grade serous carcinomas, each other, and other potential mimics are discussed, as are staging, grading, and molecular pathogenesis.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA, USA.
| | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, 20 York Street, EP2-607, New Haven, CT 06510, USA
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Zhang Y, Qu P. Factors associated with ovarian endometriosis malignancy and its recurrence in Chinese women. J OBSTET GYNAECOL 2019; 39:1148-1153. [PMID: 31307261 DOI: 10.1080/01443615.2019.1603209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, the risk factors for ovarian endometriosis (OE) malignancy and its recurrence were explored in Chinese women. For OE malignancy occurrence, the age of marriage, abortion times, course of OE, body mass index (BMI), other benign uterine complications, and shorter parturition times were identified as risk factors using univariate analyses. Among them, age at marriage, course of OE, BMI, and decreased parturition times were identified as risk factors using multivariate analyses. For OE malignancy recurrence, the risk factors included clinical staging, histological classification, and chemotherapy by univariate analysis; and clinical stage, clear-cell carcinoma, and fewer chemotherapy cycles by multivariate analyses. In summary, we concluded that higher ages at marriage, longer courses of ovarian endometriosis, shorter parturition times, and additional benign uterine complications may increase the risk of OE malignancy. Advanced clinical stages, clear-cell carcinomas, and fewer chemotherapy cycles may promote OE malignancy recurrence. Impact statement What is already known on this subject? Endometriosis is one of the most common gynaecological diseases. Although endometriosis is not a malignant disease, endometriosis cells have characteristics similar to cancer cells. The risk of malignant transformation rates of ovarian endometriosis is said to be 1:18. However, epidemiological evidence based on large population research in ovarian endometriosis malignancy is lacking. In addition, there were few studies focussing on the long-term prognosis of ovarian endometriosis malignancies. What do the results of this study add? This study revealed the possible occurrence and recurrence risk factors of ovarian endometriosis malignancy using univariate and multivariate statistics analyses. What are the implications of these findings for clinical practice and/or further research? A clinical retrospective study with a longer follow-up period is suggested for assessing the occurrence and recurrence risk factors for ovarian endometriosis malignancies.
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Affiliation(s)
- Ying Zhang
- Department of Gynecology, Tianjin Central Hospital of Gynecology Obstetrics , Tianjin , China
| | - Pengpeng Qu
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology Obstetrics , Tianjin , China
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Li Q, Sun Y, Zhang X, Wang L, Wu W, Wu M, Meng C, Liu G. Endometriosis-associated ovarian cancer is a single entity with distinct clinicopathological characteristics. Cancer Biol Ther 2019; 20:1029-1034. [PMID: 30913953 DOI: 10.1080/15384047.2019.1595278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: To compare the clinicopathological features and chemotherapy response of ovarian clear cell carcinoma (CCC) and endometrioid carcinoma (EC) associated with endometriosis or not. Methods: This was a retrospective study of 128 patients diagnosed with CCC and EC from 2002 to 2017. Clinicopathological features and chemotherapy response were analyzed. Results:There were 34 women with endometriosis-associated ovarian cancer (EAOC) and 94 with non-endometriosis associated ovarian cancer (non-EAOC) according to Sampson's and Scott's criteria. The mean diagnosis age in the EAOC group was 48.65 vs. 54.39 years in non-EAOC (p = 0.002). Compared with non-EAOC, the EAOC patients were more likely to have an earlier menarche age (13 vs. 14 years, p = 0.001), a higher incidence of infertility (26.47% vs. 10.64%, p = 0.026), and an earlier stage tumor (91.18% vs. 73.40% in stages I-II, p = 0.032). At a median follow-up time of 32.9 months, overall survival among patients with EAOC was significantly longer (109.8 vs. 47.4 months, p = 0.007). Association with endometriosis (p = 0.033) was the significant favorable prognostic factors associated with survival. However, stratifying by stage, the overall survival advantage of EAOC was not significant. Although EAOC had a better prognosis, no difference was observed in chemotherapy response between the two groups (p = 0.535). Conclusions: The EAOC patients were often diagnosed at a younger age, an earlier stage, and related to nulliparity and infertility. Patients with EAOC had a better prognosis than non-EAOC, early stage rather than association with endometriosis may be the driver of survival.
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Affiliation(s)
- Qianwen Li
- a Department of Gynecology , Affiliated Hospital of Hebei University , Hebei , China
| | - Yue Sun
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Xiang Zhang
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Linping Wang
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Wenling Wu
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Meijing Wu
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Chao Meng
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
| | - Guoyan Liu
- b Department of Gynecology and Obstetrics , Tianjin Medical University General Hospital , Tianjin , China
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Kajiyama H, Suzuki S, Yoshihara M, Tamauchi S, Yoshikawa N, Niimi K, Shibata K, Kikkawa F. Endometriosis and cancer. Free Radic Biol Med 2019; 133:186-192. [PMID: 30562557 DOI: 10.1016/j.freeradbiomed.2018.12.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/21/2022]
Abstract
Endometriosis, characterized by the presence of extra-uterine endometrium, is a common gynecologic disorder in reproductive-age women. Although the detailed molecular mechanism of etiology remains unelucidated, recent studies have gradually revealed both genetic and epigenetic backgrounds of the development of endometriosis. In clinical practice, endometriosis has been recognized as a precursor lesion of several types of malignancies and endometriosis-associated carcinoma. An imbalance between reactive oxygen species and local antioxidants has been reported to contribute to the development of endometriosis-associated carcinoma as well as the pathophysiology of this disease through a systemic inflammatory response in the peritoneal cavity. This review mainly presents an epidemiology, possible etiology of endometriosis, precursor lesions, molecular features, and the association between the microenvironmental accumulations of oxidative stress in endometriosis-associated ovarian cancer progression.
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Affiliation(s)
- Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan.
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
| | - Kiyosumi Shibata
- Department of Obstetrics and Gynecology, Bantane Hospital, Fujita Health University, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Japan
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Ovarian carcinomas: at least five different diseases with distinct histological features and molecular genetics. Hum Pathol 2018; 80:11-27. [DOI: 10.1016/j.humpath.2018.06.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022]
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Zhao T, Shao Y, Liu Y, Wang X, Guan L, Lu Y. Endometriosis does not confer improved prognosis in ovarian clear cell carcinoma: a retrospective study at a single institute. J Ovarian Res 2018; 11:53. [PMID: 29941051 PMCID: PMC6019519 DOI: 10.1186/s13048-018-0425-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Considered as the precursor lesion of a subset of ovarian clear cell carcinoma (OCCC), the prognostic role of endometriosis in OCCC patients remains controversial. This study aimed to investigate the prognostic role of coexisting endometriosis in the survival of patients with OCCC, and also sought to identify other prognostic factors. RESULTS A total of 125 patients were diagnosed with OCCC during the study period. Of these, 55 (44.0%) patients had coexisting endometriosis. Patients with endometriosis were younger (p = 0.030), had smaller tumor diameter (p = 0.005) and lower preoperative CA125 levels (p = 0.005). More patients with endometriosis had International Federation of Gynecology and Obstetrics (FIGO) stage I disease (83.6% vs. 51.4%, p = 0.000) and exhibited sensitivity to platinum-based regimen (89.6% vs. 66.7%, p = 0.003). Univariate and multivariate analysis revealed that coexisting endometriosis was not a predictor of 5-year overall survival (OS) or progression-free survival (PFS) of OCCC patients. For OS, chemosensitivity was the only useful prognostic factor (Hazards ratio (HR) 109.33, 95% Confidence Interval (CI) 23.46-511.51; p = 0.000). For PFS, the useful prognostic factors were ascites (HR 2.78, 95% CI 1.21-6.47; p = 0.016), FIGO stage (HR 1.61, 95% CI 1.04-2.49; p = 0.033), and chemosensitivity (HR 101.60, 95% CI 29.45-350.49; p = 0.000). Moreover, higher FIGO stage was the only risk factor for resistance to platinum-based chemotherapy (Exp (B) = 0.292, 95% CI 0.123-0.693; p = 0.005). CONCLUSIONS In this study, coexisting endometriosis was not a prognostic factor for the survival of OCCC patients. The most important predictor of both 5-year OS and PFS was chemosensitivity to platinum-based regimen, which decreased significantly with increase in FIGO stage.
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Affiliation(s)
- Ting Zhao
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yu Shao
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yan Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Xiao Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Luyao Guan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yuan Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China.
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Vitale SG, Capriglione S, Peterlunger I, La Rosa VL, Vitagliano A, Noventa M, Valenti G, Sapia F, Angioli R, Lopez S, Sarpietro G, Rossetti D, Zito G. The Role of Oxidative Stress and Membrane Transport Systems during Endometriosis: A Fresh Look at a Busy Corner. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7924021. [PMID: 29743986 PMCID: PMC5883985 DOI: 10.1155/2018/7924021] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/18/2018] [Indexed: 11/17/2022]
Abstract
Endometriosis is a condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to a chronic inflammatory reaction. It is one of the most widespread gynecological diseases with a 10-15% prevalence in the general female population, rising up to 30-45% in patients with infertility. Although it was first described in 1860, its etiology and pathogenesis are still unclear. It is now accepted that inflammation plays a central role in the development and progression of endometriosis. In particular, it is marked by an inflammatory process associated with the overproduction of an array of inflammatory mediators such as prostaglandins, metalloproteinases, cytokines, and chemokines. In addition, the growth and adhesion of endometrial cells in the peritoneal cavity due to reactive oxygen species (ROS) and free radicals lead to disease onset, its ensuing symptoms-among which pain and infertility. The aim of our review is to evaluate the role of oxidative stress and ROS in the pathogenesis of endometriosis and the efficacy of antioxidant therapy in the treatment and mitigation of its symptoms.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Isabel Peterlunger
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Salvatore Lopez
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Diego Rossetti
- Unit of Gynecology and Obstetrics, Desenzano del Garda Hospital, Section of Gavardo, Via A. Gosa 74, 25085 Gavardo, Italy
| | - Gabriella Zito
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Via dell'Istria 65/1, 34137 Trieste, Italy
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Demographic, Clinical, and Prognostic Factors of Ovarian Clear Cell Adenocarcinomas According to Endometriosis Status. Int J Gynecol Cancer 2018; 27:1804-1812. [PMID: 28976447 DOI: 10.1097/igc.0000000000001102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Women with endometriosis carry an increased risk for ovarian clear cell adenocarcinomas (CCCs). Clear cell adenocarcinoma may develop from endometriosis lesions. Few studies have compared clinical and prognostic factors and overall survival in patients diagnosed as having CCC according to endometriosis status. METHODS Population-based prospectively collected data on CCC with coexisting pelvic (including ovarian; n = 80) and ovarian (n = 46) endometriosis or without endometriosis (n = 95) were obtained through the Danish Gynecological Cancer Database. χ Test, independent-samples t test, logistic regression, Kaplan-Meier test, and Cox regression were used. Statistical tests were 2 sided. P values less than 0.05 were considered statistically significant. RESULTS Patients with CCC and pelvic or ovarian endometriosis were significantly younger than CCC patients without endometriosis, and a higher proportion of them were nulliparous (28% and 31% vs 17% (P = 0.07 and P = 0.09). Accordingly, a significantly higher proportion of women without endometriosis had given birth to more than 1 child. Interestingly, a significantly higher proportion of patients with ovarian endometriosis had pure CCCs (97.8% vs 82.1%; P = 0.001) as compared with patients without endometriosis. Overall survival was poorer among CCC patients with concomitant ovarian endometriosis (hazard ratio, 2.56 [95% confidence interval, 1.29-5.02], in the multivariate analysis. CONCLUSIONS Age at CCC diagnosis and parity as well as histology differ between CCC patients with and without concomitant endometriosis. Furthermore, CCC patients with concomitant ovarian endometriosis have a poorer prognosis compared with endometriosis-negative CCC patients. These differences warrant further research to determine whether CCCs with and without concomitant endometriosis develop through distinct pathogenic pathways.
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Ozyurek ES, Yoldemir T, Kalkan U. Surgical challenges in the treatment of perimenopausal and postmenopausal endometriosis. Climacteric 2018; 21:385-390. [DOI: 10.1080/13697137.2018.1439913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- E. S. Ozyurek
- Department of Obstetrics and Gynecology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - T. Yoldemir
- Department of Obstetrics and Gynecology, Marmara University Hospital, Istanbul, Turkey
| | - U. Kalkan
- Department of Obstetrics and Gynecology, Egemed Hospital, Aydin, Turkey
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Sahin H, Sari ME, Cuylan ZF, Haberal AN, Sirvan L, Coban G, Yalcin I, Güngör T, Celik H, Meydanli MM, Ayhan A. Is the presence of endometriosis associated with a survival benefit in pure ovarian clear cell carcinoma? Arch Gynecol Obstet 2018; 297:1005-1013. [PMID: 29383437 DOI: 10.1007/s00404-018-4651-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to compare the prognoses of women with pure ovarian clear cell carcinoma (OCCC) arising from endometriosis to those of women with pure OCCC not arising from endometriosis treated in the same manner. METHODS A dual-institutional, retrospective database review was performed to identify patients with pure OCCC who were treated with maximal or optimal cytoreductive surgery (CRS) followed by paclitaxel/carboplatin chemotherapy between January 2006 and December 2016. Patients were divided into two groups according to the detection of cancer arising in endometriosis or not, on the basis of pathological findings. Demographic, clinicopathological, and survival data were collected, and prognosis was compared between the two groups. RESULTS Ninety-three women who met the inclusion criteria were included. Of these patients, 48 (51.6%) were diagnosed with OCCC arising in endometriosis, while 45 (48.4%) had no concomitant endometriosis. OCCC arising in endometriosis was found more frequently in younger women and had a higher incidence of early stage disease when compared to OCCC patients without endometriosis. The 5-year overall survival (OS) rate of the patients with OCCC arising in endometriosis was found to be significantly longer than that of women who had OCCC without endometriosis (74.1 vs. 46.4%; p = 0.003). Although univariate analysis revealed the absence of endometriosis (p = 0.003) as a prognostic factor for decreased OS, the extent of CRS was identified as an independent prognostic factor for both recurrence-free survival (hazard ratio (HR) 8.7, 95% confidence interval (CI) 3.15-24.38; p < 0.001) and OS (HR 11.7, 95% CI 3.68-33.71; p < 0.001) on multivariate analysis. CONCLUSION Our results suggest that endometriosis per se does not seem to affect the prognosis of pure OCCC.
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Affiliation(s)
- Hanifi Sahin
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey
| | - Mustafa Erkan Sari
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey.
| | - Zeliha Firat Cuylan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey
| | - Asuman Nihan Haberal
- Department of Pathology, School of Medicine, Baskent University, Y. Bahcelievler Mah., Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey
| | - Levent Sirvan
- Department of Pathology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gonca Coban
- Department of Gynecologic Oncology, School of Medicine, Baskent University, Y. Bahcelievler Mah Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey
| | - Ibrahim Yalcin
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey
| | - Husnu Celik
- Department of Gynecologic Oncology, School of Medicine, Baskent University, Y. Bahcelievler Mah Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Talatpasa Bulvarı, Altındag, 06230, Ankara, Turkey
| | - Ali Ayhan
- Department of Gynecologic Oncology, School of Medicine, Baskent University, Y. Bahcelievler Mah Mareşal Fevzi Çakmak Cad., No: 45, Çankaya, Ankara, Turkey
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Significance of Ovarian Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma. Int J Gynecol Cancer 2018; 28:11-18. [DOI: 10.1097/igc.0000000000001136] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IntroductionThe aim of this study was to evaluate the significance of ovarian endometriosis on the prognosis of ovarian clear cell carcinoma (OCCC).MethodsPatients with OCCC were divided into 2 groups according to the presence of ovarian endometriosis: group 1, no coexisting ovarian endometriosis; group 2, clear cell carcinoma arising from ovarian endometriosis or the presence of ovarian endometriosis elsewhere in the ovary. Clinicopathologic characteristics, disease-free survival (DFS), and overall survival (OS) were compared between the 2 groups.ResultsOf 155 patients with OCCC, 77 were categorized into group 1 and 78 into group 2. Group 2 patients were younger than group 1 (median age, 48 vs 51 years; P = 0.005) and had higher incidence of early-stage disease (stage I, 77% vs 58%; P = 0.001) and lower incidence of lymph node metastasis (4% vs 17%; P = 0.008). Group 2 patients were observed to have a significantly higher 5-year DFS (P < 0.001) and OS (P = 0.001) compared with group 1. In stage I disease, group 2 had a significantly higher 5-year DFS (P = 0.004) and OS (P = 0.016) than did group 1. In the multivariate analysis, coexisting endometriosis and advanced International Federation of Obstetrics and Gynecology stage were significant factors for both DFS and OS rates.ConclusionsOvarian clear cell carcinoma with endometriosis was found more frequently in younger women and had a higher incidence of early-stage disease and a lower incidence of lymph node metastasis compared with OCCC without endometriosis. Ovarian endometriosis was associated with improved prognostic factors and a better DFS and OS even in stage I disease. Ovarian endometriosis was an independent prognostic factor for OCCC.
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Bai H, Sha G, Xiao M, Gao H, Cao D, Yang J, Chen J, Wang Y, Zhang Z, Shen K. The prognostic value of pretreatment CA-125 levels and CA-125 normalization in ovarian clear cell carcinoma: a two-academic-institute study. Oncotarget 2017; 7:15566-76. [PMID: 26863639 PMCID: PMC4941261 DOI: 10.18632/oncotarget.7216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/28/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The present study investigated the clinical implications of pretreatment carbohydrate antigen 125 (CA-125) levels and CA-125 normalization in patients with ovarian clear cell carcinoma (CCC), and it provides useful information for the improvement of monitoring strategies for this lethal disease. METHODS The medical records of patients with ovarian CCC who had undergone primary staging surgery or cytoreductive surgery followed by systemic chemotherapy were retrospectively reviewed. A range of clinico-pathological parameters were collected and examined. RESULTS A total of 375 women were included in the analysis. FIGO stage (p < 0.001) was identified as the only significant prognostic factor for relapse. Residual tumor and advanced stage (p = 0.001 and p < 0.001, respectively) were identified as independent adverse factors for survival. The potential risk factors associated with elevated pretreatment CA-125 levels included advanced-stage disease, positive residual tumors and negative endometriosis (p < 0.001, p = 0.001 and p <0.001, respectively). Pretreatment CA-125 levels were not associated with relapse-free survival (RFS) or overall survival (OS) (p = 0.060 and p = 0.176, respectively). CA-125 normalization after chemotherapy exhibited a positive linear correlation with advanced stage (r = 0.97, p = 0.001) and residual tumor (r = 0.81, p = 0.027) and a negative relationship with 5-year RFS (r = -0.97, p = 0.002) and 5-year OS (r = -0.97, p= 0.001). Patients with CA-125 levels that normalized before cycle 2 of chemotherapy had a similar prognosis as patients whose CA-125 levels normalized prior to chemotherapy (RFS: p = 0.327; OS: p = 0.654). By contrast, patients with CA-125 levels that normalized after cycle 2 of chemotherapy or never normalized were significantly more likely to experience disease progression. CONCLUSIONS Pretreatment CA-125 levels are not very useful for predicting clinical outcome. CA-125 levels following treatment are a valid indicator for treatment monitoring. CA-125 normalization after the completion of cycle 1 of chemotherapy represents a distinct inflection point for decreased RFS and OS.
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Affiliation(s)
- Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guisha Sha
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Meizhu Xiao
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huiqiao Gao
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Wang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Role of endometriosis as a prognostic factor for post-progression survival in ovarian clear cell carcinoma. Mol Clin Oncol 2017; 7:1027-1031. [PMID: 29285368 DOI: 10.3892/mco.2017.1468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/08/2017] [Indexed: 11/05/2022] Open
Abstract
The clinical significance of coexistence of endometriosis (EM) in ovarian clear cell carcinoma (CCC) has not yet been determined. The aim of the present study was to analyze the correlation of endometriosis with clinicopathological factors in CCC. The cases with CCC that received primary debulking surgery at the present hospital between 1990 and 2013 were identified. Retrospective analysis was conducted to evaluate the association between complications with EM and clinicopathological features in CCC. Of the 105 cases enrolled in the study, 45 cases were complicated with EM, and 60 cases did not have EM (non-EM). The patients with EM were diagnosed at a younger age (P=0.03), and at earlier stages (P<0.01) compared with non-EM cases. Although there was no significant difference of progression-free survival (P=0.36), complications with EM were identified as an independent prognostic factor for overall survival (OS; P<0.01) by multivariate analysis. A total of 48 patients (45.7%) developed recurrence: 18 patients in EM-group and 30 patients in non-EM group. There were no significant differences of clinicopathological factors in the treatment at recurrence between both groups. Recurrent cases in EM had significantly worse post-progression survival (PPS) compared with recurrent non-EM group (P<0.01). Multivariate analysis for PPS demonstrated that complications with EM (P<0.01) were identified as a worse prognostic factor. In CCC, the complication with EM was identified as a significant worse prognostic factor for PPS in recurrent cases. Additionally, EM was significantly associated with OS in all cases with CCC. Novel treatment strategies are therefore necessary for recurrent CCC, particularly for cases exhibiting EM.
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Bai H, Cao D, Yuan F, Sha G, Yang J, Chen J, Wang Y, Zhang Z, Shen K. Prognostic value of endometriosis in patients with stage I ovarian clear cell carcinoma: Experiences at three academic institutions. Gynecol Oncol 2016; 143:526-531. [DOI: 10.1016/j.ygyno.2016.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Demographic Clinical and Prognostic Factors of Primary Ovarian Adenocarcinomas of Serous and Clear Cell Histology-A Comparative Study. Int J Gynecol Cancer 2016; 26:82-90. [PMID: 26569060 DOI: 10.1097/igc.0000000000000585] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare clinical demographic and prognostic factors as well as overall survival in a nationwide cohort of patients diagnosed with ovarian clear cell carcinoma (oCCC) and high grade ovarian serous adenocarcinoma (oSAC) during 2005 to 2013. MATERIALS AND METHODS Population-based prospectively collected data on oCCC (n = 179) and oSAC (n = 2363) cases were obtained from the Danish Gynecological Cancer Database. χ, Fischer or Wilcoxon-Mann-Whitney, multivariate logistic regression, univariate Kaplan-Meier, and multivariate Cox regression tests were used. Statistical tests were 2-sided. P values less than 0.05 were considered statistically significant. RESULTS The oCCC cases were significantly younger than oSAC cases. An inverse association between ever smoking and oCCC as compared to oSAC was observed and a significantly higher proportion of oCCC was found to be nulliparous (odds ratio, 0.62; 95% confidence interval, 0.37-0.92).Although more oSAC than oCCC cases diagnosed in stage III or IV were referred to neoadjuvant chemotherapy, a higher proportion of oCCC achieved complete cytoreduction at primary debulking surgery and/or had lymphadenectomy performed; overall survival were poorer among oCCC than oSAC cases in analyses restricted to stages III and IV (odds ratio, 1.87; 95% confidence interval, 1.35-2.61), whereas no difference between early stage oCCC and oSAC was observed. CONCLUSIONS The study confirms that demographic features and risk factors differ between oCCC and oSAC cases. Furthermore, our findings confirm that advanced stages of oCCC have a poorer prognosis compared with oSAC probably because of the resistance toward adjuvant chemotherapy. The observed differences highlight the need for subtype-specific research and individualized treatment within ovarian cancer.
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Prat J. Pathology of borderline and invasive cancers. Best Pract Res Clin Obstet Gynaecol 2016; 41:15-30. [PMID: 28277307 DOI: 10.1016/j.bpobgyn.2016.08.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 12/31/2022]
Abstract
Epithelial ovarian tumors are heterogeneous neoplasms primarily classified according to cell type. They are further subdivided into benign, borderline, and malignant (carcinomas), and this subdivision is very important as it correlates with behavior. Borderline ovarian tumors show epithelial proliferation higher than that seen in their benign counterparts and variable nuclear atypia; however, in contrast to carcinomas, there is no destructive stromal invasion, and their prognosis is much better. Ovarian carcinomas are the most common ovarian cancers and the most lethal gynecological malignancies. On the basis of histopathology and molecular genetics, they are divided into five types (high-grade serous (70%), endometrioid (10%), clear cell (10%), mucinous (3%), and low-grade serous carcinomas (<5%)), which are morphologically diverse and account for over 95% of cases. These tumors are essentially distinct diseases, as indicated by differences in epidemiological and genetic risk factors, precursor lesions, patterns of spread, molecular alterations, response to chemotherapy, and prognosis. For a successful specific treatment, reproducible histopathological diagnosis of the tumor cell type is critical.
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Affiliation(s)
- Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.
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Poole EM, Konstantinopoulos PA, Terry KL. Prognostic implications of reproductive and lifestyle factors in ovarian cancer. Gynecol Oncol 2016; 142:574-87. [DOI: 10.1016/j.ygyno.2016.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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Abstract
Endometriosis may be a precursor lesion for some epithelial ovarian cancers (EOCs), especially those of clear cell and endometrioid histologies. The causality of this relationship remains controversial and in need of further investigation because the high prevalence of endometriosis and high mortality of EOC carry significant public health implications if the association is real. Endometriosis-associated ovarian cancer (EAOC) often presents at an earlier stage and with lower-grade lesions than non-EAOC. After surgical resection, these patients also tend to have less residual disease than do patients with non-EAOC. Survival has been reported to be better for women with EAOC. The tumor suppression gene, ARID1A, is frequently disrupted in EAOC. The ARID1A mutation has been reported in preneoplastic lesions and may be an early marker in the transformation of endometriosis into cancer. The current evidence in respect to critical molecular pathways underscores the need to investigate possible role of targeted therapies in the treatment of EAOC.
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Amaral PI, Silva A, Lacerda A, Barros C. Synchronous endometrioid endometrial and ovarian cancer in a 34-year-old woman. BMJ Case Rep 2015; 2015:bcr-2015-210940. [PMID: 26351313 DOI: 10.1136/bcr-2015-210940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ovarian cancer is the leading cause of death from gynaecological malignancy in developed countries. Synchronous endometrioid endometrial and ovarian cancer in patients appears with different clinical characteristics compared to patients with isolated endometrial cancer. A 34-year-old woman with lower abdominal pain of 1 year duration presented at the emergency department. On gynaecological examination, she had a left and midline pelvic mass. A transvaginal ultrasound showed it to be a complex hypervascularised mass, with cystic and solid components on left adnexal region. Ectopic pregnancy and pelvic inflammatory disease were excluded. Serum levels of tumour marker CA125 and ROMA were increased. The MR showed a complex mass, suggestive of primary fallopian tube or ovarian tumour. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection and subcolonic omentectomy. Histopathology revealed a synchronous endometrioid endometrial and ovarian cancer.
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Affiliation(s)
| | - Abel Silva
- Centro Hospitalar Lisboa Central-Maternidade Dr Alfredo da Costa, Lisboa, Portugal
| | - Abílio Lacerda
- Centro Hospitalar Lisboa Central-Maternidade Dr Alfredo da Costa, Lisboa, Portugal
| | - Carlos Barros
- Centro Hospitalar Lisboa Central-Maternidade Dr Alfredo da Costa, Lisboa, Portugal
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Guo SW. Endometriosis and ovarian cancer: potential benefits and harms of screening and risk-reducing surgery. Fertil Steril 2015; 104:813-830. [PMID: 26335131 DOI: 10.1016/j.fertnstert.2015.08.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/23/2022]
Abstract
Although endometriosis is well recognized as a benign gynecologic condition, its association with ovarian cancer (OVCA) has frequently been reported. Review articles on this topic are voluminous, yet there seems to be no consensus as to whether endometriosis is truly a precursor of OVCA and whether any screening or risk-reducing surgery should be instituted, on the basis of our current knowledge. In this review, published data are compiled and critically appraised. Through this critical appraisal, it seems clear that the strongest evidence seems to come from prevalence data. This type of data also suggests a reduced risk of certain histotypes (mainly type II) of OVCA in women with endometriosis. This may explain the rather moderate increase in risk as shown in epidemiologic studies. Even with this moderate increase in OVCA risk, caution should be exercised because of apparent bias in favor of publication of positive results, extensive heterogeneities among prevalence estimates, and inverse relationship between estimates and sizes of the studies. Many molecular studies are conflicting, and earlier studies showing molecular aberrations involved in genomic instability and mutation that enable malignant transformation are not replicated in later studies. Given the low incidence of OVCA and the rather moderate increase in risk of mostly type I tumors, screening seems to be ill-advised, and risk-reducing surgery such as salpingectomy with or without oophorectomy does not seem to yield any substantial benefit to women with endometriosis.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, People's Republic of China; Department of Biochemistry and Molecular Biology, Shanghai College of Medicine, Fudan University, Shanghai, People's Republic of China.
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28
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Kim HS, Kim MA, Lee M, Suh DH, Kim K, No JH, Chung HH, Kim YB, Song YS. Effect of Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma: A Two-Center Cohort Study and Meta-analysis. Ann Surg Oncol 2015; 22:2738-2745. [DOI: 10.1245/s10434-014-4319-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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29
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Comparison of pure and mixed-type clear cell carcinoma of the ovary: a clinicopathological analysis of 341 Chinese patients. Int J Gynecol Cancer 2015; 24:1590-6. [PMID: 25254564 DOI: 10.1097/igc.0000000000000275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the clinicopathological features of pure and mixed-type ovarian clear cell carcinoma (CCC) in Chinese patients. METHODS Patients with ovarian CCC treated in our institution between 1982 and 2012 were identified by reviewing the database and medical charts. Patients were assigned into 2 groups based on histology (pure or mixed). Comparison of clinicopathological parameters was performed to determine the similarities and/or differences between pure and mixed CCC. Kaplan-Meier model was used in survival analysis. RESULTS Of 341 patients with ovarian CCC, 46 (13.5%) mixed tumors were identified, and the most common combination was clear cell/endometrioid, accounting for 56.5%. Patients with mixed-type CCC tended to have higher level of serum cancer antigen 125 (P = 0.023) and advanced tumor stage (P = 0.001). No difference was observed in other features including age, tumor size, residual disease, lymph node metastasis, and coexisting endometriosis. Tumor recurrence occurred in 47.8% and 58.1% in patients with pure and mixed histology, respectively (P = 0.209). Two groups had comparable platinum-sensitive disease (42.1% in pure and 44.0% in mixed type, P = 0.860). Patients with pure CCC had an improved median survival (105 vs 56 months), although statistical significance was not achieved. Histology subclassification of mixed tumor revealed that patients with clear cell/endometrioid histology had better survival outcome than those with clear cell/serous type (median survival, 140 vs 43 months, P = 0.004; median progression-free survival, 49 vs 12 months, P = 0.001). CONCLUSIONS Patients with mixed CCC tended to have elevated serum cancer antigen 125 and advanced tumor stage. However, no significant difference was observed between the pure and mixed tumors regarding prognosis.
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Pavone ME, Lyttle BM. Endometriosis and ovarian cancer: links, risks, and challenges faced. Int J Womens Health 2015; 7:663-72. [PMID: 26170722 PMCID: PMC4494101 DOI: 10.2147/ijwh.s66824] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Endometriosis is a benign gynecological condition characterized by specific histological, molecular, and clinical findings. It affects 5%-10% of premenopausal women, is a cause of infertility, and has been implicated as a precursor for certain types of ovarian cancer. Advances in technology, primarily the ability for whole genome sequencing, have led to the discovery of new mutations and a better understanding of the function of previously identified genes and pathways associated with endometriosis associated ovarian cancers (EAOCs) that include PTEN, CTNNB1 (β-catenin), KRAS, microsatellite instability, ARID1A, and the unique role of inflammation in the development of EAOC. Clinically, EAOCs are associated with a younger age at diagnosis, lower stage and grade of tumor, and are more likely to occur in premenopausal women when compared with other ovarian cancers. A shift from screening strategies adopted to prevent EAOCs has resulted in new recommendations for clinical practice by national and international governing bodies. In this paper, we review the common histologic and molecular characteristics of endometriosis and ovarian cancer, risks associated with EAOCs, clinical challenges and give recommendations for providers.
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Affiliation(s)
- Mary Ellen Pavone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brianna M Lyttle
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
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31
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Bennett JA, Dong F, Young RH, Oliva E. Clear cell carcinoma of the ovary: evaluation of prognostic parameters based on a clinicopathological analysis of 100 cases. Histopathology 2015; 66:808-15. [DOI: 10.1111/his.12514] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Jennifer A Bennett
- James Homer Wright Pathology Laboratories; Massachusetts General Hospital; Boston MA USA
- Department of Pathology; Harvard Medical School; Boston MA USA
| | - Fei Dong
- James Homer Wright Pathology Laboratories; Massachusetts General Hospital; Boston MA USA
- Department of Pathology; Harvard Medical School; Boston MA USA
| | - Robert H Young
- James Homer Wright Pathology Laboratories; Massachusetts General Hospital; Boston MA USA
- Department of Pathology; Harvard Medical School; Boston MA USA
| | - Esther Oliva
- James Homer Wright Pathology Laboratories; Massachusetts General Hospital; Boston MA USA
- Department of Pathology; Harvard Medical School; Boston MA USA
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32
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Aci�n P, Velasco I, Aci�n M, Capello C, Vela P. Epithelial Ovarian Cancers and Endometriosis. Gynecol Obstet Invest 2015; 79:126-35. [DOI: 10.1159/000367597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
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33
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Králíčková M, Vetvicka V. Endometriosis and ovarian cancer. World J Clin Oncol 2014; 5:800-805. [PMID: 25493219 PMCID: PMC4259943 DOI: 10.5306/wjco.v5.i5.800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/18/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is the leading cause of morbidity among premenopausal women and the complex pathogenesis of this disease remains controversial despite extensive research. This disease represents one of the most common gynecological problems. It is generally believed that this disease is due primarily to retrograde menstruation or transplantation of shed endometrium. Based on overwhelming data, ovarian endometrioma is considered a neoplastic process, since most endometriosis-associated ovarian carcinoma occur in the presence of atypical ovarian endometriosis. A study comparing patients with typical epithelial ovarian cancer with endometriosis-associated ovarian cancer demonstrated that the patients with the latter disease strongly differ in both biological and histological characteristics. The prevelance of this disease is not completely established, but approximately 15 percent of women suffer from this disease. In addition, we know about the possible links between endometriosis and cancer for almost 100 years. Despite clear evidence revealing that endometriosis increases ovarian cancer risks, it is possible that it may not affect disease progression after the appearance of ovarian cancer. However, despite clear evidence revealing that endometriosis increases ovarian cancer risk, our knowledge of the risk factors is far from established. In our review, we focused on the most recent approaches including possible biomarkers and genetic approaches.
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Ye S, Yang J, You Y, Cao D, Bai H, Lang J, Chen J, Shen K. Comparative study of ovarian clear cell carcinoma with and without endometriosis in People's Republic of China. Fertil Steril 2014; 102:1656-62. [DOI: 10.1016/j.fertnstert.2014.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 12/23/2022]
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Pathogenesis of the Endometriosis-Related Ovarian Neoplasms. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-013-0073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Kim HS, Kim TH, Chung HH, Song YS. Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis. Br J Cancer 2014; 110:1878-90. [PMID: 24518590 PMCID: PMC3974076 DOI: 10.1038/bjc.2014.29] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/31/2013] [Accepted: 01/08/2014] [Indexed: 01/06/2023] Open
Abstract
Background: The risk and prognosis of ovarian cancer have not been well established in women with endometriosis. Thus, we investigated the impact of endometriosis on the risk and prognosis for ovarian cancer, and evaluated clinicopathologic characteristics of endometriosis-associated ovarian cancer (EAOC) in comparison with non-EAOC. Methods: After we searched an electronic search to identify relevant studies published online between January 1990 and December 2012, we found 20 case–control and 15 cohort studies including 444 255 patients from 1 625 potentially relevant studies. In the meta-analysis, ovarian cancer risk by endometriosis and clinicopathologic characteristics were evaluated using risk ratio (RR) or standard incidence ratio (SIR), and prognosis was investigated using hazard ratio (HR) with 95% confidence interval (CI). Heterogeneity was evaluated using Higgins I2 to select fixed-effect (I2 ⩽50%) or random effects models (I2>50%), and found no publication bias using funnel plots with Egger's test (P>0.05). Furthermore, we performed subgroup analyses based on study design, assessment of endometriosis, histology, disease status, quality of study and adjustment for potential confounding factors to minimise bias. Results: Endometriosis increased ovarian cancer risk in case–control or two-arm cohort studies (RR, 1.265; 95% CI, 1.214–1.318) and single-arm cohort studies (SIR, 1.797; 95% CI, 1.276–2.531), which were similar in subgroup analyses. Although progression-free survival was not different between EAOC and non-EAOC (HR, 1.023; 95% CI, 0.712–1.470), EAOC was associated with better overall survival than non-EAOC in crude analyses (HR, 0.778; 95% CI, 0.655–0.925). However, progression-free survival and overall survival were not different between the two groups in subgroup analyses. Stage I–II disease, grade 1 disease and nulliparity were more common in EAOC (RRs, 1.959, 1.319 and 1.327; 95% CIs, 1.367–2.807, 1.149–1.514 and 1.245–1.415), whereas probability of optimal debulking surgery was not different between the two groups (RR, 1.403; 95% CI, 0.915–2.152). Furthermore, endometrioid and clear cell carcinomas were more common in EAOC (RRs, 1.759 and 2.606; 95% CIs, 1.551–1.995 and 2.225–3.053), whereas serous carcinoma was less frequent in EAOC than in non-EAOC (RR, 0.733; 95% CI, 0.617–0.871), and there was no difference in the risk of mucinous carcinoma between the two groups (RR, 0.805; 95% CI, 0.584–1.109). These clinicopathologic characteristics were also similar in subgroup analyses. Conclusions: Endometriosis is strongly associated with the increased risk of ovarian cancer, and EAOC shows favourable characteristics including early-stage disease, low-grade disease and a specific histology such as endometrioid or clear cell carcinoma. However, endometriosis may not affect disease progression after the onset of ovarian cancer.
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Affiliation(s)
- H S Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daekak-ro Jongno-gu, Seoul 110-744, Republic of Korea
| | - T H Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daekak-ro Jongno-gu, Seoul 110-744, Republic of Korea
| | - H H Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daekak-ro Jongno-gu, Seoul 110-744, Republic of Korea
| | - Y S Song
- 1] Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daekak-ro Jongno-gu, Seoul 110-744, Republic of Korea [2] Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-799, Republic of Korea [3] Major in Biomodulation, World Class University, Seoul National University, Seoul 151-742, Republic of Korea
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Davis M, Rauh-Hain JA, Andrade C, Boruta DM, Schorge JO, Horowitz NS, May T, del Carmen MG. Comparison of clinical outcomes of patients with clear cell and endometrioid ovarian cancer associated with endometriosis to papillary serous carcinoma of the ovary. Gynecol Oncol 2014; 132:760-6. [PMID: 24440832 DOI: 10.1016/j.ygyno.2014.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this investigation was to compare outcomes of patients with clear cell carcinoma (CCC) and endometrioid carcinoma (EC) of the ovary associated with endometriosis to patients with ovarian papillary serous carcinoma (PSC). METHODS Patients with CCC and EC of the ovary associated with endometriosis were identified and matched by age and stage to PSC controls. Student's t test and chi square test were used to analyze continuous and categorical data. The Kaplan-Meier method was used for survival analysis. RESULTS 67 cases associated with endometriosis were identified, of which 45 were arising in endometriosis. Cases were matched to 134 PSC controls. 27 patients with tumors associated with endometriosis presented at stage I (40.3%), 27 at stage II (40.3%), ten at stage III (14.9%) and three at stage IV (4.5%). There was no difference in rate of optimal cytoreduction or response to chemotherapy in cases vs. PSC controls. There was a significant increase in synchronous endometrial cancer in tumors associated with endometriosis compared to PSC (25.4% vs. 3.7%; P<0.001). 18 cases (26.9%) had recurrent disease vs. 55 (41%) controls (P=0.03). The 5-year disease-free survival (DFS) and overall survival (OS) of patients with tumors associated with endometriosis compared to PSC controls were 75% vs. 55% (P=0.03) and 85% vs. 77% (P=0.2), respectively. CONCLUSIONS Patients with tumors associated with endometriosis had a higher rate of synchronous endometrial cancer. Cases also demonstrated a lower rate of recurrence and improved 5 year DFS; however, this did not translate into a difference in OS.
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Affiliation(s)
- Michelle Davis
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolina Andrade
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David M Boruta
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John O Schorge
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neil S Horowitz
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Taymaa May
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcela G del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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A recurrence-predicting prognostic factor for patients with ovarian clear-cell adenocarcinoma at reproductive age. Int J Clin Oncol 2013; 19:921-7. [DOI: 10.1007/s10147-013-0645-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
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Chang CYY, Chen Y, Lai MT, Chang HW, Cheng J, Chan C, Chen CM, Lee SC, Lin YJ, Wan L, Tsai PW, Yang SH, Chung C, Sheu JJC, Tsai FJ. BMPR1B up-regulation via a miRNA binding site variation defines endometriosis susceptibility and CA125 levels. PLoS One 2013; 8:e80630. [PMID: 24339876 PMCID: PMC3855056 DOI: 10.1371/journal.pone.0080630] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 10/04/2013] [Indexed: 12/11/2022] Open
Abstract
Background Bone morphogenetic protein receptor I B (BMPR1B) is a transmembrane receptor mediating TGF-β signal transduction. Recent studies indicate a tumor suppressor role for BMPR1B in ovarian cancer. Polymorphism at BMPR1B 3′UTR within the miR-125b binding site alters its binding affinity toward the miRNA, which may result in insufficient post-transcriptional repression. Methods Single-nucleotide polymorphisms rs1970801, rs1434536, and rs11097457 near the miR-125b binding site in BMPR1B were genotyped by Taqman assay on 193 endometriosis patients and 202 healthy controls. BMPR1B and CA125 levels in ectopic endometrial tissues were evaluated by quantitative PCR and immunohistochemistry. Luciferase reporter assay was utilized to verify regulatory roles of BMPR1B 3′UTR with allelic variants of rs1434536 in a cell line model. Cell proliferation and migration were recorded, while expression of BMPR1B, CA125, glucocorticoid receptor (GCCR) and IL-1β were measured by quantitative PCR in endometrial cells transfected with wild-type or mutated miR-125b. Results This study found two endometriosis-associated SNPs, rs1434536 (P = 0.010) and rs1970801 (P = 0.0087), located within and next to a miR-125b binding site on BMPR1B. Interestingly, patients with homozygous variant alleles at rs1434536 showed significantly lower serum CA125 levels. Immunohistochemistry staining further confirmed inverse correlation between BMPR1B and CA125 levels in three rs1434536 genotypes. Cell assays demonstrated the variant allele of rs1434536 up-regulating BMPR1B at both mRNA and protein levels, which negatively correlated with CA125 and IL-1β levels. Disruption of the binding between miR-125b and BMPR1B hampered abnormal cell proliferation. Conclusions SNPs of BMPR1B within and next to the miR-125b binding site manifested strong correlation with endometriosis development in a Taiwanese cohort. Disrupting the binding of miR-125b toward BMPR1B would increase protein expression, diminishing abnormal cell proliferation as well as serum and cellular CA125 levels. Genetic variation at the miR-125b binding site may play functional roles to protect against endometriosis progression.
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Affiliation(s)
- Cherry Yin-Yi Chang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan ; Department of Public Health, China Medical University, Taichung, Taiwan ; School of Medicine, China Medical University, Taichung, Taiwan
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Heidemann LN, Hartwell D, Heidemann CH, Jochumsen KM. The relation between endometriosis and ovarian cancer - a review. Acta Obstet Gynecol Scand 2013; 93:20-31. [PMID: 24011403 DOI: 10.1111/aogs.12255] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 08/30/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endometriosis is known to harbor characteristics substantiating its possible role as a precursor of ovarian cancer. OBJECTIVE To assess the quality of the literature regarding the association between endometriosis and ovarian cancer and to estimate the extent of this relation. METHODS An electronic literature search was conducted in PubMed and 1112 articles dealing with the relation between endometriosis and ovarian cancer were identified. Original articles based on case-control studies, cohort studies and cross-sectional studies were included. Studies consisting of populations with self-reported endometriosis were excluded, as were articles with fewer than 20 cases of ovarian cancer. Twenty-eight studies underwent detailed quality assessments based on the checklists developed by the Scottish Intercollegiate Guidelines Network (SIGN). Meta-analyses were conducted on selected subgroups of ovarian cancer with coexisting endometriosis. RESULTS None of the 28 studies was given the highest possible rating using the SIGN checklists. The risk of ovarian cancer in women with endometriosis was reported to be a standardized incidence ratio of 1.43-8.95, a rate ratio of 1.6-2.88, an odds ratio of 1.34, with a prevalence of ovarian cancer in 2.0-17.0% of women with endometriosis. Conversely, the prevalence of endometriosis in women with ovarian cancer ranged from 3.4 to 52.6%. Meta-analysis results were weakened by heterogeneity. CONCLUSION There is sufficient evidence to conclude that there is an increased risk of developing clear-cell and endometrioid epithelial ovarian cancer for women with histologically verified endometriosis. Nonetheless, prospective cohort studies assessing the relation between endometriosis and ovarian cancer will increase knowledge in this field.
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Affiliation(s)
- Lene N Heidemann
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
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Buis CCM, van Leeuwen FE, Mooij TM, Burger CW. Increased risk for ovarian cancer and borderline ovarian tumours in subfertile women with endometriosis. Hum Reprod 2013; 28:3358-69. [PMID: 24014607 DOI: 10.1093/humrep/det340] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is ovarian or extra-ovarian endometriosis associated with an increased risk of ovarian cancer and borderline ovarian tumours (BOT)? SUMMARY ANSWER We found a 3- to 8-fold increased risk of ovarian tumours associated with endometriosis: the magnitude of the risk increase depended on the definition of endometriosis. WHAT IS KNOWN ALREADY There is increasing evidence of an association between endometriosis and increased risk of ovarian cancer. However, most reports were based on self-reported diagnosis of endometriosis. STUDY DESIGN, SIZE, DURATION We conducted a nationwide historic cohort study among women with subfertility problems between 1980 and 1995. For this analysis we selected all cohort members with endometriosis, and a comparison group of subfertile women (male factor or idiopathic) without endometriosis (total cohort of 8904 women). Median follow-up time was 15.2 for the entire study population. PARTICIPANTS/MATERIALS, SETTING, METHODS For this analysis we selected all cohort members with (n = 3657) and without (n = 5247) evidence of endometriosis. Seventy-eight per cent of diagnoses of endometriosis were confirmed by pathology report, and 22% was self-reported endometriosis (positive predictive value of 73%). We linked the cohort with the Dutch Pathology Database and the Netherlands Cancer Registry to assess the occurrence of ovarian cancer and BOT between January 1989 and June 2007. MAIN RESULTS AND THE ROLE OF CHANCE We observed a substantially increased risk of all ovarian malignancies combined in women with endometriosis when we based the definition of endometriosis on self-report, medical records information at subfertility treatment and/or the nationwide pathology database (hazard ratio (HR) 8.2; 95% confidence interval (CI) 3.1-21.6). The HR associated with endometriosis was 12.4 (95% CI 2.8-54.2) for ovarian cancer and 5.5 (95% CI 1.5-20.2) for BOT. When we excluded information from the pathology database, HRs were 3.0 (95% CI 1.5-6.1) for all ovarian tumours, 4.3 (95% CI 1.6-11.2) for ovarian cancer and 1.9 (95% CI 0.6-5.8) for BOT. Both ovarian and extra-ovarian endometriosis carried a significantly increased risk for ovarian cancer and BOT. LIMITATIONS, REASONS FOR CAUTION We did not have information on oral contraceptive use and parity for 23.4 and 3.4%, of women in the analytic cohort, respectively. Furthermore, a limitation of our study, and also of other studies, is that the date of diagnosis of endometriosis is usually made long after the onset of the disease. Also, the number of cases in the cohort is small (n = 34), resulting in wide CIs. WIDER IMPLICATIONS OF THE FINDINGS The fact that endometriosis was assessed before diagnosis of ovarian malignancy and the high degree of medical confirmation in our study likely contribute to the validity of our estimate of a 3- to 8-fold increased risk of ovarian tumours associated with endometriosis. The risk of ovarian malignancies associated with endometriosis was much higher in analyses including information on endometriosis from the nationwide pathology database, implying that risk estimates from studies using self-reported information on endometriosis may be too low due to non-differential misclassification bias. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- C C M Buis
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Erasmus Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
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Borghese B, Santulli P, Vaiman D, Alexandre J, Goldwasser F, Chapron C. Les cancers de l’ovaire associés à l’endométriose : physiopathologie et conséquences sur la pratique clinique. ACTA ACUST UNITED AC 2013; 42:325-33. [DOI: 10.1016/j.jgyn.2013.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/19/2013] [Accepted: 02/28/2013] [Indexed: 01/07/2023]
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Wang S, Qiu L, Lang JH, Shen K, Yang JX, Huang HF, Pan LY, Wu M. Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis. Am J Obstet Gynecol 2013; 208:413.e1-5. [PMID: 23220508 DOI: 10.1016/j.ajog.2012.12.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/28/2012] [Accepted: 12/03/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore the differences between women with endometriosis associated ovarian cancer and typical epithelial ovarian cancer. STUDY DESIGN The medical charts of total 226 patients with epithelial ovarian cancer treated at Peking Union Medical College Hospital between March 2011 and March 2012 were reviewed. Histology evaluation determined endometriosis associated ovarian cancer (n = 17) or non-endometriosis associated ovarian cancer (n = 209). RESULTS Compared with non-endometriosis associated ovarian cancer, patients with endometriosis associated ovarian cancer were proved: (1) to be younger and more likely to be premenopausal at diagnosis of epithelial ovarian cancer (P = .03 and .005, respectively); (2) to have lower preoperative serum level of Ca125 (mean: 122.9 vs 1377.5 U/mL, P < .001) and more likely to display normal Ca125 level (P < .001); (3) to be identified at the earlier stage (stage I, P < .001); (4) to have completely different distribution of histological subtypes (significant overrepresentation of clear cell and endometrioid carcinoma). CONCLUSION As such, patients with endometriosis associated ovarian cancer differ from non-endomertiosis associated ovarian cancer in many of their critical clinical and biologic characteristics.
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Clear cell carcinoma of the female genital tract (not everything is as clear as it seems). Adv Anat Pathol 2012; 19:296-312. [PMID: 22885379 DOI: 10.1097/pap.0b013e31826663b1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clear cell carcinoma has a storied history in the female genital tract. From the initial designation of ovarian clear cell adenocarcinoma as "mesonephroma" to the linkage between vaginal clear cell carcinoma and diethylstilbestrol exposure in utero, gynecologic tract clear cell tumors have puzzled investigators, posed therapeutic dilemmas for oncologists, and otherwise presented major differential diagnostic challenges for pathologists. One of the most common errors in gynecologic pathology is misdiagnosis of clear cell carcinoma, on both frozen section and permanent section. Given the poor response to platinum-based chemotherapy for advanced-stage disease and increased risk of thromboembolism, accurate diagnosis of clear cell carcinoma is important in the female genital tract. This review (1) presents the clinical and pathologic features of female genital tract clear cell carcinomas; (2) highlights recent molecular developments; (3) identifies areas of potential diagnostic confusion; and (4) presents solutions for these diagnostic problems where they exist.
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Yamanoi K, Mandai M, Suzuki A, Matsumura N, Baba T, Yoshioka Y, Kosaka K, Konishi I. Synchronous primary corpus and ovarian cancer: High incidence of endometriosis and thrombosis. Oncol Lett 2012; 4:375-380. [PMID: 22970036 DOI: 10.3892/ol.2012.770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/14/2012] [Indexed: 11/05/2022] Open
Abstract
In an attempt to clarify the clinical characteristics of synchronous primary endometrial and ovarian cancer (SPC), we reviewed the clinicopathological features of 13 cases treated in the Department of Gynecology and Obstetrics at Kyoto University Hospital over the last 6 years and compared them with 186 cases of primary uterine corpus cancer (PCC) and 136 cases of primary ovarian cancer (POC). Comparisons were performed based on clinicopathological factors, including age, BMI, parity, complication of thrombosis and FIGO stage. For SPC patients, the mean age was 51.5 years; 6 (46%) were nulliparous, and 7 (53%) had complicated thrombosis. All had well-differentiated endometrial cancer and 12 (92%) had endometrioid cancer in the ovary. The mean age of the SPC patients was significantly lower than that of the PCC patients (51.5 vs. 58.9 years). Thrombosis occurred in the SPC patients at a significantly higher rate than in both the PCC and POC patients. When the incidence of endometriosis and the regularity of menstruation were compared between patients who developed SPC with those who develop PCC at a young age (under 45 years), the SPC patients exhibited a significantly higher rate of endometriosis (100 vs. 35%), whereas the PCC patients exhibited a higher rate of irregular menstruation (53 vs. 15%, p=0.05). As for thrombosis, the age and FIGO stage of thrombosis-positive patients were significantly higher than those of thrombosis-negative patients in PCC and POC, while in SPC patients there was no such difference. In conclusion, this study demonstrated the differences in clinical features between SPC and PCC, and also novel features of SPC, namely endometriosis and thrombosis, which are essential in the management of this disease.
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Affiliation(s)
- Koji Yamanoi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Mangili G, Bergamini A, Taccagni G, Gentile C, Panina P, Viganò P, Candiani M. Unraveling the two entities of endometrioid ovarian cancer: a single center clinical experience. Gynecol Oncol 2012; 126:403-7. [PMID: 22609111 DOI: 10.1016/j.ygyno.2012.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Due to the increasing prevalence of the benign condition, ovarian carcinoma arising from endometriosis is emerging as a relevant clinical entity with an unclear biological signature. We have investigated clinical and histologic features of endometriosis-associated endometrioid ovarian cancer using an institutional retrospective database. METHODS Patients diagnosed with endometrioid ovarian cancer at our institution were divided into two groups according to the fulfillment or not of Sampson's and Scott's criteria for the detection of endometriosis-associated ovarian cancer. Clinical and histological data were reported and compared. Survival analysis was obtained using the log-rank test in an unadjusted Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model to establish independent factors associated with endometriosis-associated endometrioid ovarian cancer and to identify predictors of survival. The degree of concordance was evaluated by Cohen's Kappa measures. RESULTS Patients with endometriosis-associated endometrioid ovarian cancer were significantly younger, had a lower disease stage (62% vs 23%; p=0.003), a less prevalent high grade tumor (38% vs 82%; p=0.002) and a higher prevalence of squamous and mucinous metaplasia. The rate of endometrial cancer diagnosis was significantly higher in women with endometriosis-associated endometrioid ovarian cancer (33%) than in other patients (11%) (p=0.04) with a 92% concordance between ovarian and endometrial histologic tumor grade. A significant difference in survival rate could not be demonstrated between patients with or without endometriosis. CONCLUSIONS The analysis of a retrospective endometrioid ovarian cancer database may allow to suggest a 40 molecular, morphological and clinical parallelism between endometrial and endometrioid ovarian cancers.
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Affiliation(s)
- Giorgia Mangili
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milano, Italy.
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Endometriosis Does Not Confer Improved Prognosis in Ovarian Carcinoma of Uniform Cell Type. Am J Surg Pathol 2012; 36:688-95. [DOI: 10.1097/pas.0b013e31824b6eed] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prat J. Ovarian carcinomas: five distinct diseases with different origins, genetic alterations, and clinicopathological features. Virchows Arch 2012; 460:237-49. [PMID: 22322322 DOI: 10.1007/s00428-012-1203-5] [Citation(s) in RCA: 374] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 12/30/2022]
Abstract
Malignant epithelial tumors (carcinomas) are the most common ovarian cancers and also the most lethal gynecological malignancies. Based on histopathology and molecular genetic alterations, ovarian carcinomas are divided into five main types (high-grade serous (70%), endometrioid (10%), clear cell (10%), mucinous (3%), and low-grade serous carcinomas (<5%)) that account for over 95% of cases. These types are essentially distinct diseases, as indicated by differences in epidemiological and genetic risk factors, precursor lesions, patterns of spread, and molecular events during oncogenesis, response to chemotherapy, and prognosis. For a successful specific treatment, reproducible histopathological diagnosis of the tumor cell type is critical. The five tumor types are morphologically diverse and resemble carcinomas of the uterus. Actually, recent investigations have demonstrated that a significant number of cancers, traditionally thought to be primary ovarian tumors (particularly serous, endometrioid, and clear cell carcinomas), originate in the fallopian tube and the endometrium and involve the ovary secondarily. This review summarizes recent advances in the molecular pathology which have greatly improved our understanding of the biology of ovarian carcinoma and are also relevant to patient management.
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Affiliation(s)
- Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quinti 87-89, 08041 Barcelona, Spain.
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D’Angelo E, Prat J. Classification of ovarian carcinomas based on pathology and molecular genetics. Clin Transl Oncol 2012; 12:783-7. [DOI: 10.1007/s12094-010-0599-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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