| Objectives: 1. To investigate the different clinicopathologic features of clear cell carcinoma(CCC) and endometrioid carcinoma(EC) arising in endometriosis or not.2. To explore the risk factors for malignant transformation of endometriosis.Methods: 1. Patients diagnosed with CCC and EC(EAOC) between 2000 and 2014 had been divided into two groups according to Sampson’s and Scott’s critera. One was patients with EAOC arising in endometriosis(EM-EAOC), another was cases diagnosed EAOC not arising in endometriosis(NEM-EAOC). Clinical and pathological data were reviewed and compared. Cox regression analysis and Kaplan–Meier test were used to calculate survival prognostic factors. Multivarite analysis of chemotherapy response related factors were performed using logistic regression model.2. Ovarian cancer arising in endometriosis was defined as the EM- EAOC, while endometriosis benign lesion group was defined as the EM. The clinical data of patients were collected. T test and chi-square test were used to analysis the risk factors of malignant transformation of endometriosis.Results: 1. The median age in EM-EAOC group was 49.31 vs 53.56 years in NEM-EAOC(P=0.029). In comparison with NEM-EAOC, the EM-EAOC patients were more likely to be have lower CA125 level(P=0.037), larger tumor size( 12.36±4.38 vs 10.27±4.82 cm, P=0.043) and early-stage tumors(89.66% vs 71.25%, P=0.046). Comparing with NEM-EAOC, patients in EM-EAOC group had earlier menarche age(62.07% vs 36.25%, P=0.016), more frequent dysmenorrhea(51.72% vs 46.25%, P=0.018), menstrual disorder(41.37% vs 20.00%, P=0.024) and higher incidence of infertility(31.03% vs 12.50%, P=0.024); lower gravidity(P=0.011) and delivery number(P=0.001). Median overall survival for EM-EAOC was 108 versus 46 months for NEM-EAOC(P=0.009). Endometriosis(P=0.038), ascites(P=0.022), tumor stage(P=0.000), and chemoresistance(P=0.000) were the significant prognostic factors associated with survival. Removing the influence of tumor type, stage and grade, endometriosis was associated with chemosensitivity. After controlling for age, stage, grade, and chemoresistance, association with endometriosis was an independent predictor of better survival in ovarian cancer.2. Compared with EM control group, patients in EM-EAOC had a higher proportion of > 45 years(68.97% vs 12.00%, P=0.000); high prevalence of hormone therapy(20.69% vs 4.00%, P=0.020); higher levels of serum-CA125(P=0.006); higher FSH levels(46.40 vs 5.81 m IU/ml, P=0.000) and LH levels(32.16 vs 6.10 m IU/ml, P=0.000); lower P levels(0.56 vs 1.39ng/ml, P=0.002), larger tumor diameter(12.36±4.38 vs 5.14±1.68 cm, P=0.045), higher incidence of tumor on the left side(58.62% vs 32.00%, P=0.021), more cases with abenomyosis(27.59% vs 8.00%, P=0.022), higher ratio of the tumor wall with the papillary structure(41.38% vs 4.00%, P=0.000), pouch or solid change(79.31% vs 8.00%, P=0.000) and abundant blood flow signals(68.97% vs 18.00%, P=0.000).Conclusions: 1. EM-EAOC and NEM-EAOC may have different clinicopathologic characteristics and the presence of endometriosis associated with better prognosis and chemosensitivity.2. Advanced age(> 45 years of age), serum CA125 level >200 U/ML, disorders of hormone, larger tumor diameter, ultrasonic manifestations of capsule wall with papillary structure and abundant blood flow might be high risk factors for endometriosis of malignant transformation. |
