Association Between Endometriosis and Prognosis of Ovarian Cancer: An Updated Meta-Analysis

Abstract

ObjectiveIncreased risk of ovarian cancer (OC) among endometriosis patients has been proposed. However, the association between endometriosis and prognosis of OC remains controversial. This study evaluated whether endometriosis had influence on the survival outcomes of OC through a meta-analysis.MethodsRelevant studies were retrieved from PubMed, Embase, and Web of Science databases and were evaluated using the Newcastle-Ottawa Quality Assessment Scale. Effect size was presented as hazard ratio (HR) and 95% confidence interval (CI). Heterogeneity test evaluation was performed using Cochran’s Q test and I2 statistics. Publication bias was determined using Egger’s test. Statistical analysis was performed using Stata 12.0 software.ResultsTwenty-one studies involving 38641 patients were included. For the total OC, there were significant differences in overall survival (OS) [HR (95% CI)=0.67 (0.55, 0.80), P<0.001] and progression-free survival (PFS) [HR (95% CI)=0.58 (0.42, 0.81), P=0.001] between endometriosis-associated ovarian cancer (EAOC) and non-EAOC patients in the random-effects models (P<0.05). For ovarian clear cell cancer, there were significant differences in terms of OS [HR (95% CI)=0.63 (0.48, 0.83), P=0.001] and PFS [HR (95% CI)=0.67 (0.52, 0.87), P=0.002] between EAOC and non-EAOC patients in the fixed-effects models (P>0.05). Subgroup analysis suggested no significant differences between EAOC and non-EAOC in OS and PFS in the univariate analysis per subgroup, and PFS in the American subgroup (P>0.05).ConclusionEAOC patients tended to have better OS and PFS than non-EAOC patients. Conducting higher quality prospective cohort studies with large sample sizes is recommended to confirm the authenticity of the current study’s results.Systematic Review Registrationhttps://inplasy.com/inplasy-2022-3-0109/.

Endometriosis-Related Ovarian Cancers: Evidence for a Dichotomy in the Histogenesis of the Two Associated Histotypes

“…The stage at diagnosis of clear cell carcinomas arising from endometriosis is expected to further decrease with the increasing use of ultrasound in the follow-up of endometriotic cysts, thus allowing clinicians to identify a subset of patients with a better prognosis. Moreover, a meta-analysis by Chen and colleagues highlighted better overall survival (OS) and progression-free survival (PSF) in patients with endometriosis-associated ovarian cancer compared to women with neoplasms not related to endometriosis [ 10 ]. More studies are needed to understand if there is a difference in terms of OS and PSF between clear cell carcinoma and endometrioid carcinoma associated with endometriosis.…”

“…Endometriosis is a benign disease, but it shares some characteristics with cancer, such as local and distant invasion, resistance to apoptosis, recurrence, angiogenesis, damage to target organs and stimulation of the inflammatory system [ 9 , 10 , 11 , 12 , 13 , 14 ]. In particular, the real precursor of ovarian cancer is represented by atypical endometriosis which is seen in 60–80% of ovarian cancers that result from endometriosis [ 2 , 4 ].In addition, the most common mutations in atypical endometriosis affect ARID1A , PIK3CA , genes coding for estrogen and progestogen receptors, KRAS and PTEN [ 2 ].…”

History of Endometriosis Is Independently Associated with an Increased Risk of Ovarian Cancer

“…Meta-analyses investigating the association between endometriosis and ovarian cancer typically report significant heterogeneity [ 19 , 45 , 46 ]. Likewise, the exact mechanisms of the endometriosis–ovarian cancer conversion are still not fully established, and the need for new approaches in the understanding of this connection is urgent [ 29 , 47 ].…”

Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook

“…Similarly, in a recent systematic review and meta-analysis that included 21 eligible studies and 38,641 patients, EAOC had better overall and progression-free survival than controls [ 87 ].…”