Recurrence Of Ovarian Endometrioma After Surgical Excision

Objective:The recurrence of endometrioma after surgical excision is a very frequent event among women in reproductive age. However, the available data about the risk factors for and the patterns of recurrence of ovarian endometrioma is still quite limited. Our study is to identify prognostic factors for ovarian endometrioma recurrence after surgical excision.Methods:A hospital-based, retrospective cohort study was conducted from January1,2010, through December31,2011, at Tongji Hospital affiliated with Tongji medical college. A total of307patients operated on for endometrioma were followed up for an average of28.6months. Twenty one potential risk factors for endometrioma recurrence were evaluated using Cox’s proportional hazards models.Results:The accumulate recurrence rate was9.5%at1year,21.9%at2year,29.2%at3year, respectively. Among21potential risk factors analyzed, total rAFS score was significantly associated with higher recurrence (OR=1.858,95%CI=1.122-3.075, P=0.016), as well as younger age at surgery (OR=0.953,95%CI=0.915-0.992, P=0.020). Semiradical surgical treatment was defined as surgical removal of cyst plus hysterectomy with preservation of bilateral or unilateral ovary. It was a significant factor that was associated with lower recurrence when compared with conservative surgery (OR=0.318,95%CI=0.107-0.951, P=0.040), and postoperative pregnancy were favorable factors for disease recurrence (OR=0.217,95%CI=0.102-0.460, P<0.001).Conclusion:Endometrioma recurrence is inversely associated with age at surgery and postoperative pregnancy, and may corelate with total rAFS score and conservative surgery method. Objective:To investigate the effect of GnRHa on prognosis of ovarian endometriosis after laparoscopic excision.Method:A total of293ovarian endometriosis patients who were confirmed pathologically were evaluated retrospectively.163patients treated with GnRHa after laparoscopic excision were selected as drug group, and130cases with no treatment after surgery were selected as non-drug group. The remission rate of relevant symptoms, pregnancy after surgery, recurrence rate of disease and incidence of adverse drug reactions were compared between the two groups during periodical follow-up period.Results:The symptom alleviation rate was higher and pain recurrence rate was lower in drug group when comparing with non-drug group. In addition, treatment with GnRHa could induce pregnancy after surgery. However, recurrence rate of disease between the two groups show no significant difference.Conclusion:Treatment with GnRHa after conservative laparoscopic surgery could improve disease-related pain symptoms and infertility, while no significant difference was observed when analyzed the recurrence rate. Objective:There is currently no reliable noninvasive biomarker for the clinical diagnosis and prognosis of endometriosis. Previous analyses have reported that circulating microRNAs (miRNAs) can serve as biomarkers for a number of diseases. The study aims to detect the plasma miRNAs that are differentially expressed between endometriosis patients and negative controls to evaluate the potential of these miRNAs as diagnostic and prognostic markers for endometriosis.Method:Fifty-six patients were selected;32of them had recurrence within20months after surgery, whereas the other24had not had recurrence at least30months after surgery. Plasma of40healthy women was also collected. Total RNA was extracted from each sample, then The relative expression levels of candidate miRNAs (miR-17-5p、miR-20a、 miR-199a、miR-141) were detected using quantitative RT-PCR.Results:The relative expression levels of miR-199a was found to be up-regulated in endometriosis patient samples compared with control samples, whereas miR-17-5p, miR-20a, miR-141were down-regulated in endometriosis patients. Importantly, the relative expression of miR-199a, miR-17-5p and miR-20a can be used to discriminate between recurrence and non-recurrence endometrioma. Furthermore, we investigated the diagnostic value of miR-199a, miR-17-5p and miR-20a with area under the curve of0.83[95%0.76[95%CI=0.64-0.89]、0.71[95%CI=0.58-0.83], respectively. Conclusion:Our study demonstrated that the circulating miRNAs miR-199a, miR-17-5p and miR-20a could potentially serve as noninvasive biomarkers for endometriosis. Objective:Aberrant expression of plasma miRNAs have been validated in our previous study. This study aims to detect the target genes of the miRNA that are differentially expressed between endometriosis patients and negative controls, then to investigate the function of the target gene.Method:Detect the mRNA expression of zinc finger E-box binding homeobox1(ZEB1) in40endometriotic tissues and60normal endometrial. Use immunohistoehemical method to compare the expression differences of ZEB1protein between normal endometrium and ectopic endometrium. pCI-neo-ZEBl eukaryotic expression vector was built by using gene recombination technology, then it was transfected into primary cultured endometriotic stromal cells(ESCs) and normal stromal cells by liposome. The transfection efficiency was detected by Western blot. The effects on ESCs proliferation of recombinant plasmids were detected by CCK8. The apoptosis rate of observed in ESCs after plasmid transfection was detected by flow cytometry.Results:Up-regulated ZEB1expressions in mRNA and protein level were observed in secretary phase of endometriotic tissues. ZEB1expression in ectopic endometrium was obviously higher than in normal endometrium, and the difference is significant (P<0.05). After transfection of pCI-neo-ZEB1eukaryotic expression vector, the proliferation ability of ESCs was enhanced, and the apoptosis rate was significantly reduced.Conclusion:Up-regulated ZEB1in endometriotic stromal cells induced survival and growth of endometriotic cells.