Endometriosis-associated Ovarian Cancer is a Subset With a More Favorable Outcome and Distinct Clinical-pathologic Characteristics

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.

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

“…This might explain the reason for the different results in our meta-analysis and previous meta-analyses. For example, a recent study suggested that a significantly longer DFS was found in EAOC patients (51.9 months) than in non-EAOC patients (30.5 months) ( 39 ).…”

S2k-Leitlinie Diagnostik und Therapie der Endometriose – Anforderungen an die Pathologie

“…Populationsbezogene Untersuchungen zeigen ein bis zu 4fach erhöhtes Risiko für ein Ovarialkarzinom bei Endometriosepatientinnen [ 31 , 52 ]. Unter diesen überwiegt mit knapp zwei Drittel der endometrioide Subtyp, gefolgt vom klarzelligen Karzinom (20 %), seröse und muzinöse Karzinome sind selten [ 4 , 37 , 52 ]. Das seromuzinöse Zystadenom bzw.…”

“…Untersuchungen der letzten Jahre legen nahe, dass sowohl endometrioide als auch klarzellige Ovarialkarzinome in Assoziation mit einer Endometriose eine bessere Prognose aufweisen als solche ohne [ 4 , 5 ]. Daher wird empfohlen, bei diesen beiden histologischen Subtypen mittels einer adäquaten Einbettung eine assoziierte Endometriose des Ovars nachzuweisen bzw.…”

“…In einzelnen Fällen kann ein seröses Ovarialkarzinom mit glandulärem Wachstumsmuster ein endometrioides Muster aufweisen, was differenzialdiagnostische Probleme bereiten kann. In diesem Kontext hilfreich kann die Tatsache sein, dass im Vergleich zu den weitaus häufigeren und oft bereits fortgeschrittenen high-grade serösen Ovarialkarzinomen, endometrioide Ovarialkarzinome meist im FIGO-Stadium I und II diagnostiziert werden [ 4 ]. High-grade seröse Ovarialkarzinome bei Patientinnen mit BRCA -Keimbahnmutation können bei Vorliegen des sog.…”

Utility of adjuvant whole abdominal radiation therapy in ovarian clear cell cancer (OCCC): a pragmatic cohort study of women with classic immuno-phenotypic signature

“…Occurring in younger cohorts [2,9] it is particularly aggressive when locally advanced (extra-pelvic peritoneal or lymph node dissemination), or recurrent [4,15,16]. Strongly associated with precursor endometriosis [17], Asian ethnicity (prevalence in Japanese cancer registries can exceed 40% [13]), and with unique genotypic and phenotypic signatures, the prognosis of OCCC is generally regarded as dismal due to inherent resistance to platinum-based chemotherapy [10,16]. Globally there is an exigency for a reliable adjuvant treatment for women with OCCC.…”