Endometriosis-associated ovarian cancer is a single entity with distinct clinicopathological characteristics

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 nonendometriosis 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.

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

“…( 24 ), but the ages of all the cases were mentioned in three studies ( 20 , 21 , 26 ). The remaining 17 studies reported the ages of cases in the EAOC and non-EAOC groups, and among these studies, significant differences were found between the cases belonging to different EAOC and non-EAOC age groups in ten studies ( 12 , 15 , 16 , 22 , 29 , 31 – 35 ).…”

“…The methodological quality evaluation for the 21 included studies was conducted with reference to NOS, and the results are shown in Table 2 . The NOS scores of the 21 studies ranged from 5 to 8 points, of which 5 points was evaluated for one study ( 23 ), 6 points for five studies ( 21 , 22 , 24 , 33 , 36 ), 7 points for six studies ( 16 , 20 , 25 , 28 , 29 , 31 ) and 8 points for nine studies ( 12 , 15 , 17 , 26 , 27 , 30 , 32 , 34 , 35 ). Overall, the methodological quality of the included studies was moderate.…”

“…Li et al. indicated that patients with EAOC had longer overall survival (109.8 months) than those with non-EAOC (47.4 months) ( 16 ). However, no associations between endometriosis and prognosis of OC were found in the study of Ju et al.…”

Correlation of Clinicopathological and Prognostic Characteristics between Endometriosis-Associated and Primary Ovarian Cancer

“…However, sample sizes were usually small and the results obtained were inconsistent. Some ndings suggest that ovarian endometrial carcinoma and ovarian clear cell carcinoma are early phases with better prognosis than the two pathological types of primary ovarian cancer [20][21], while other researchers have reported no obvious differences [22][23]. Here, we examined 174 cases of ovarian endometrial carcinoma and clear cell carcinoma, with a median follow-up period of 67 months.…”

MRI in the Diagnosis of Endometriosis and Related Diseases

“…Although rare (approximately 1%), the relative risk of developing ovarian cancer is up to 4.2 times greater in female with endometriosis than in the general population [ 49 ]. Patients with endometriosis-associated ovarian carcinoma (EAOC) tend to be younger (10–20 years old) and tend to have better prognoses and outcomes than female with primary epithelial ovarian cancers [ 50 ]. Scott [ 51 ] and Sampson [ 52 ] proposed the following histological criteria for EAOC: 1) coexistence of carcinoma and endometriosis within the same ovary, 2) a similar histological pattern, 3) exclusion of a second malignant tumor elsewhere, and 4) demonstration of a histology-proven transition from benign endometriosis to cancer [ 51 52 ].…”