Clinicopathological and prognostic outcomes of endometriosis-associated ovarian cancer

Öz

Aim: The aim of this study is to investigate the clinicopathological characteristics and prognostic value of endometriosis in patients with ovarian cancer. Materials and Methods: A retrospective analysis was performed on 273 patients with ovarian carcinoma between January 2013 and December 2023. Patients were stratified into endometriosis-associated ovarian carcinoma (EAOC) and non-endometriosis-associated ovarian carcinoma (non-EAOC). Clinicopathological variables, including age, menopausal status, tumor size and volume, FIGO stage, histological subtype, serum tumor markers, and survival outcomes, were evaluated. Results: EAOC patients were significantly younger than non-EAOC patients (respectively 51 ± 11.4 years, 59 ± 11.2 years; p = 0.002). EAOC cases were more frequently diagnosed at FIGO stage I than non-EAOC cases (p = 0.001), whereas FIGO stage (III) disease was more prevalent in the non-EAOC group (p = 0.007). No significant differences were observed in CA-125 levels between groups. CA 19-9 levels were elevated in the EAOC group (p = 0.012). Recurrence rates and survival outcomes did not differ significantly between the groups. Conclusion: EAOC cases were diagnosed at a younger age and presented at an earlier FIGO stage and had elevated CA 19-9 levels. However, survival outcomes did not significantly differ between EAOC and non-EAOC groups.

Anahtar Kelimeler

• Endometriosis
• Ovarian neoplasms
• Endometriosis-associated ovarian cancer
• Survival outcome

Endometriozisle ilişkili over kanserinin klinikopatolojik ve prognostik sonuçları

Öz

Amaç: Bu çalışmanın amacı, over kanseri olan hastalarda endometriozisin klinikopatolojik özelliklerini ve prognostik değerini araştırmaktır. Gereçler ve Yöntemler: Ocak 2013 ile Aralık 2023 tarihleri arasında over karsinomu tanısı alan 273 hasta retrospektif olarak analiz edildi. Hastalar, endometriozisle ilişkili over karsinomu (EAOC) ve endometriozisle ilişkili olmayan over karsinomu (non-EAOC) olmak üzere iki gruba ayrıldı. Yaş, menopoz durumu, tümör boyutu ve hacmi, FIGO evresi, histolojik alt tip, serum tümör belirteçleri ve sağkalım sonuçları gibi klinikopatolojik değişkenler değerlendirildi. Bulgular: EAOC hastaları, non-EAOC hastalarına göre anlamlı düzeyde daha gençti (sırasıyla 51 ± 11,4 yıl, 59 ± 11,2 yıl; p = 0,002). EAOC grubunda FIGO evre I’de tanı alma oranı daha yüksekti (p = 0,001), buna karşılık non-EAOC grubunda evre III hastalık daha yaygındı (p = 0,007). Gruplar arasında CA-125 düzeylerinde anlamlı fark saptanmazken, CA 19-9 düzeyleri EAOC grubunda daha yüksekti (p = 0,012). Nüks oranları ve sağkalım sonuçları gruplar arasında anlamlı fark göstermedi. Sonuç: EAOC hastaları daha genç yaşta ve daha erken FIGO evresinde tanı almakta ve CA 19-9 düzeyleri daha yüksek bulunmaktaydı. Ancak, EAOC ve non-EAOC grupları arasında sağkalım sonuçları açısından anlamlı fark gözlenmedi.

Anahtar Kelimeler

• Endometriozis
• Over neoplazileri
• Endometriozisle ilişkili over kanseri
• Sağkalım sonucu

Kaynakça

1. Sampson J. Endometrial carcinoma of the ovary arising in endometrial tissue in that organ. Arch Surg. 1925;10:1–72.
2. Giannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, et al. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers. 2021;13(16):4026.
3. Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Research. 2019;8.
4. Scott RB. Malignant changes in endometriosis. Obstet Gynecol. 1953;2:283.
5. Wang S, Qiu L, Lang JH, Shen K, Yang JX, Huang HF, et al. Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis. Am J Obstet Gynecol. 2013;208(5):413.e1-5.
6. Kondi-Pafiti A, Papakonstantinou E, Lavazzo C, Grigoriadis C, Salakos N, Gregoriou O. Clinicopathological characteristics of ovarian carcinomas associated with endometriosis. Arch Gynecol Obstet. 2012;285:479–83.
7. Noli S, Cipriani S, Scarfone G, Villa A, Grossi E, Monti E, et al. Long term survival of ovarian endometriosis associated clear cell and endometrioid ovarian cancers. Int J Gynecol Cancer. 2013;23(2):244-8.
8. Orezzoli JP, Russell AH, Oliva E, Del Carmen MG, Eichhorn J, Fuller AF. Prognostic implication of endometriosis in clear cell carcinoma of the ovary. Gynecol Oncol. 2008;110:336–44.

9. Bogani G, Matteucci L, Tamberi S, Ditto A, Sabatucci I, Murgia F, et al. RECIST 1.1 criteria predict recurrence-free survival in advanced ovarian cancer submitted to neoadjuvant chemotherapy. Eur J Obstet Gynecol Reprod Biol. 2019;237:93-9.
10. Prat J; FIGO Committee on Gynecologic Oncology. FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum: abridged republication. J Gynecol Oncol. 2015;26(2):87-9.
11. Ju UC, Kang WD, Kim SM. The effect of concurrent endometriosis on the prognosis of women with ovarian clear cell or endometrioid carcinoma. Int J Gynaecol Obstet. 2019;146(2):177-83.
12. Kumar S, Munkarah A, Arabi H, Bandyopadhyay S, Semaan A, Hayek K, et al. Prognostic analysis of ovarian cancer associated with endometriosis. Am J Obstet Gynecol. 2011;204(1):63.e1-7.
13. Dzatic-Smilijkovic O, Vasiljevic M, Djukic M, Vugdelic R, Vugdelic J. Frequency of ovarian endometriosis in epithelial ovarian cancer patients. Clin Exp Obstet Gynecol. 2011;38:394–8.
14. Chen B, Zhao L, Yang R, Xu T. New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment. Front Oncol. 2024;14:1329133.
15. Erzen M, Rakar S, Klancnik B, Syrjänen K. Endometriosis-associated ovarian carcinoma (EAOC): an entity distinct from other ovarian carcinomas as suggested by a nested case-control study. Gynecol Oncol. 2001;83(1):100-8.
16. Davis M, Rauh-Hain JA, Andrade C, Boruta DM 2nd, Schorge JO, Horowitz NS, et al. 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(3):760-6.
17. Komiyama S, Aoki D, Tominaga E, Nobuyuki S, Udagawa Y, Nozawa S. Prognosis of Japanese patients with ovarian clear cell carcinoma associated with pelvic endometriosis: clinicopathologic evaluation. Gynecol Oncol. 1999;72(3):342–6.
18. Lim MC, Chun KC, Shin SJ, Lee IH, Lim KT, Cho CH, et al. Clinical presentation of endometrioid epithelial ovarian cancer with concurrent endometriosis: a multicenter retrospective study. Cancer Epidemiol Biomarkers Prev. 2010;19(2):398-404.
19. Pavone ME, Lyttle BM. Endometriosis and ovarian cancer: links, risks, and challenges faced. Int J Womens Health. 2015;7:663-72.
20. Mangili G, Bergamini A, Taccagni G, Gentile C, Panina P, Viganò P, et al. Unraveling the two entities of endometrioid ovarian cancer: a single center clinical experience. Gynecol Oncol. 2012;126(3):403-7.
21. Lyttle B, Bernardi L, Pavone ME. Ovarian cancer in endometriosis: clinical and molecular aspects. Minerva Ginecol. 2014;66(2):155-64.
22. Taniguchi F, Harada T, Kobayashi H, Hayashi K, Momoeda M, Terakawa N. Clinical characteristics of patients in Japan with ovarian cancer presumably arising from ovarian endometrioma. Gynecol Obstet Invest. 2014;77(2):104–10.
23. Chen B, Zhao L, Yang R, Xu T. New insights about endometriosis-associated ovarian cancer: pathogenesis, risk factors, prediction and diagnosis and treatment. Front Oncol. 2024;14:1329133.
24. Shinmura H, Yoneyama K, Harigane E, Tsunoda Y, Fukami T, Matsushima T, et al. Use of tumor markers to distinguish endometriosis-related ovarian neoplasms from ovarian endometrioma. Int J Gynecol Cancer. 2020;30(6):831–6.
25. Ren T, Wang S, Sun J, Qu JM, Xiang Y, Shen K, et al. Endometriosis is the independent prognostic factor for survival in Chinese patients with epithelial ovarian carcinoma. J Ovarian Res. 2017;10:67.
26. Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, et al. Significance of ovarian endometriosis on the prognosis of ovarian clear cell carcinoma. Int J Gynecol Cancer. 2018;28(1):11–8.
27. Hermens M, van Altena AM, van der Aa M, Bulten J, van Vliet HAAM, Siebers AG, et al. Ovarian cancer prognosis in women with endometriosis: a retrospective nationwide cohort study of 32,419 women. Am J Obstet Gynecol. 2021;224(3):284.e1–e10.
28. Li Q, Sun Y, Zhang X, Wang L, Wu W, Meng C, et al. Endometriosis-associated ovarian cancer is a single entity with distinct clinicopathological characteristics. Cancer Biol Ther. 2019;20(8):1029–34.
29. 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(1):53.
30. Wang H, Chen C, Wang D, Zhu Y, Chen P. Correlation of clinicopathological and prognostic characteristics between endometriosis-associated and primary ovarian cancer. BMC Cancer. 2023;23(1):1210.