Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression

Candost Hanedan; Sefa Kelekçi

doi:10.47582/jompac.1899461

Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression

Abstract

Aims: To evaluate clinical predictors of postoperative recurrence in ovarian endometrioma and to investigate the association between epithelial follistatin immunohistochemical expression and recurrence after surgery. Methods: This retrospective study included patients who underwent surgery for ovarian endometrioma between 2008 and 2013. Demographic, clinical, and surgical data and recurrence characteristics were analyzed. Follistatin expression in endometriotic glandular epithelial cells was assessed immunohistochemically using a binary scoring system (positive vs. negative). Factors associated with recurrence were evaluated statistically. Results: Fifty patients were included, and recurrence occurred in 24 (48%). Advanced-stage disease was significantly more common in patients with recurrence (66.7% vs. 30.8%, p=0.034), and previous endometriosis surgery was markedly higher in the recurrence group (50.0% vs. 3.8%, p<0.001). Postoperative pregnancy occurred less frequently among patients with recurrence (8.3% vs. 30.8%, p=0.042). Bilateral disease showed a non-significant trend toward recurrence (p=0.08). Cytoplasmic epithelial follistatin staining was present in 28% of patients and was not associated with recurrence (p=0.860). ROC analysis showed no discriminative ability of follistatin staining for predicting recurrence (AUC=0.511; 95% CI: 0.349–0.673). Conclusion: Postoperative recurrence of ovarian endometrioma appears to be mainly influenced by established clinical factors, whereas epithelial follistatin expression does not provide prognostic value for recurrence prediction.

Keywords

Supporting Institution

This study was supported by the Scientific Research Projects Coordination Unit of İzmir Katip Çelebi University.

Project Number

Not available

Ethical Statement

This study was approved by the İzmir Katip Çelebi University Ethics Committee (Decision No: 250) and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

Thanks

This manuscript was derived from the first author's medical specialty thesis and was supported by the Scientific Research Projects Coordination Unit of İzmir Katip Çelebi University.

References

Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789-1799. doi:10.1016/S0140-6736(04)17403-5
Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):235-258. doi:10.1016/s0889-8545(05)70302-8
Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod. 2009;24(2):254-269. doi:10.1093/humrep/den379
Vercellini P, Somigliana E, Viganò P, De Matteis S, Barbara G, Fedele L. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online. 2010;21(2):259-265. doi:10.1016/j.rbmo.2010.04.018
Busacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. 2003;15(4):321-326. doi: 10.1097/01.gco.0000084247.09900.4f
Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update. 2009;15(4):441-461. doi:10.1093/humupd/dmp007
Fedele L, Bianchi S, Zanconato G, Berlanda N, Raffaelli R, Fontana E. Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery. Fertil Steril. 2006;85(3):694-699. doi:10.1016/j.fertnstert.2005.08.028
Park JS, Lee JH, Kim M, Chang HJ, Hwang KJ, Chang KH. Endometrium from women with endometriosis shows increased proliferation activity. Fertil Steril. 2009;92(4):1246-1249. doi:10.1016/j.fertnstert.2009.04.025

Yalcin SE, Ocal I, Yalcin Y, et al. Evaluation of the Ki-67 Proliferation Index and urocortin expression in women with ovarian endometriomas. Eurasian J Med. 2017;49(2):107-112. doi:10.5152/eurasianjmed. 2017. 17070
Phillips DJ. Activins, inhibins and follistatins in the large domestic species. Domest Anim Endocrinol. 2005;28(1):1-16. doi:10.1016/j.domaniend.2004.05.006
Florio P, Reis FM, Torres PB, et al. High serum follistatin levels in women with ovarian endometriosis. Hum Reprod. 2009;24(10):2600-2606. doi:10.1093/humrep/dep195
Parazzini F, Bertulessi C, Pasini A, et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol. 2005;121(2):216-219. doi:10.1016/j.ejogrb.2004.11.033
Busacca M, Marana R, Caruana P, et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol. 1999; 180(3 Pt 1):519-523. doi:10.1016/s0002-9378(99)70247-4
Bloise E, Couto HL, Massai L, et al. Differential expression of follistatin and FLRG in human breast proliferative disorders. BMC Cancer. 2009;9: 320. doi:10.1186/1471-2407-9-320
Rombauts L, Donoghue J, Cann L, Jones RL, Healy DL. Activin-A secretion is increased in the eutopic endometrium from women with endometriosis. Aust N Z J Obstet Gynaecol. 2006;46(2):148-153. doi:10. 1111/j.1479-828X.2006.00546.x
Ren P, Chen FF, Liu HY, et al. High serum levels of follistatin in patients with ovarian cancer. J Int Med Res. 2012;40(3):877-886. doi:10.1177/ 147323001204000306
Reis FM, Luisi S, Abrão MS, et al. Diagnostic value of serum activin A and follistatin levels in women with peritoneal, ovarian and deep infiltrating endometriosis. Hum Reprod. 2012;27(5):1445-1450. doi:10. 1093/humrep/des055

Details

Primary Language

English

Subjects

Obstetrics and Gynaecology

Journal Section

Research Article

Authors

Candost Hanedan ^*
0000-0003-3435-8943
Türkiye

Sefa Kelekçi
0000-0002-9952-3068
Türkiye

Publication Date

March 27, 2026

Submission Date

February 28, 2026

Acceptance Date

March 22, 2026

Published in Issue

Year 2026 Volume: 7 Number: 2

DOI

https://doi.org/10.47582/jompac.1899461

IZ

https://izlik.org/JA98YD69WX

Cite

RIS / Bibtex

APA

Hanedan, C., & Kelekçi, S. (2026). Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression. Journal of Medicine and Palliative Care, 7(2), 381-385. https://doi.org/10.47582/jompac.1899461

AMA

1.Hanedan C, Kelekçi S. Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression. J Med Palliat Care / JOMPAC / jompac. 2026;7(2):381-385. doi:10.47582/jompac.1899461

Chicago

Hanedan, Candost, and Sefa Kelekçi. 2026. “Clinical Predictors of Postoperative Recurrence in Ovarian Endometrioma: Evaluation of Follistatin Expression”. Journal of Medicine and Palliative Care 7 (2): 381-85. https://doi.org/10.47582/jompac.1899461.

EndNote

Hanedan C, Kelekçi S (March 1, 2026) Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression. Journal of Medicine and Palliative Care 7 2 381–385.

IEEE

[1]C. Hanedan and S. Kelekçi, “Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 2, pp. 381–385, Mar. 2026, doi: 10.47582/jompac.1899461.

ISNAD

Hanedan, Candost - Kelekçi, Sefa. “Clinical Predictors of Postoperative Recurrence in Ovarian Endometrioma: Evaluation of Follistatin Expression”. Journal of Medicine and Palliative Care 7/2 (March 1, 2026): 381-385. https://doi.org/10.47582/jompac.1899461.

JAMA

1.Hanedan C, Kelekçi S. Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression. J Med Palliat Care / JOMPAC / jompac. 2026;7:381–385.

MLA

Hanedan, Candost, and Sefa Kelekçi. “Clinical Predictors of Postoperative Recurrence in Ovarian Endometrioma: Evaluation of Follistatin Expression”. Journal of Medicine and Palliative Care, vol. 7, no. 2, Mar. 2026, pp. 381-5, doi:10.47582/jompac.1899461.

Vancouver

1.Candost Hanedan, Sefa Kelekçi. Clinical predictors of postoperative recurrence in ovarian endometrioma: evaluation of follistatin expression. J Med Palliat Care / JOMPAC / jompac. 2026 Mar. 1;7(2):381-5. doi:10.47582/jompac.1899461