META Analysis Of Correlation Between Endometriosis And Risk Of Ovarian Tumor

Objective Endometriosis is a common gynecological disease,which has the activity of endometrial tissue(glands and stroma)appear outside the uterus,usually in the form of benign morphological features in pathology.However endometriosis is similar with malignant tumors,which has the clinical manifestations of infiltration,planting characteristics and damaging to the surrounding tissue and distanting metastasis and easy recurrence.Sampson believed that the pathological changes of endometriosis occurrence of endometrial tissue outflow from the uterine cavity through the fallopian tube to backward ovarian tissue,the pathological changes may lead to the occurrence of ectopic endometrial tissue malignant transformation,and then put forward the relevant theory of endometriosis canceration.With the deepening of the research on the mechanism of the ovary,the theory of dualism and the theory of the origin of the ovary has made the researchers pay more attention to the relationship between endometriosis and ovarian cancer.And more and more epidemiological and histological studies have shown that a certain proportion of endometriosis will be the formation of morphological changes,from atypical endometrial tissue into ovarian cancer.Researchers from all over the world in recent years began to focus on whether endometriosis may increase the risk of ovarian cancer,and conducted a series of biological research,clinical and epidemiological studies on this research purpose.At present,it is generally believed that the increasedrisk of ovarian cancer may be influenced by genetic and non genetic factors.Lead to malignant transformation of endometriosis occurrence basis including atypical endometriosis,endometrial tissue gene mutation,heme and free iron ions caused by oxidative stress and chronic inflammation,steroid hormones(estrogen and progesterone)factors in five aspects,including atypical endometriosis is considered to be precancerous lesions the main.In clinical research,endometriosis is a benign disease,but its relationship with benign ovarian tumor,borderline tumor and ovarian cancer is not clear.Current epidemiological studies have shown that endometriosis may increase the incidence of ovarian cancer,and even affect the survival rate of patients.However,although some epidemiological studies have not found the relationship between endometriosis and ovarian cancer incidence and survival,there is still no clear conclusion.At present,the relationship between endometriosis and the prognisos and risk of ovarian cancer risk does not quite be understood.Thus,we design the relevant Meta to analysis the correlation of endometriosis on the risk and prognosis for ovarian cancer,and evaluated pathological characteristics of endometriosis associated ovarian cancer(EAOC)and non-EAOC.Methods According to the Cochrane system evaluation method,we searched Pub Med,EMbase,The Cochrane Library,CBM,CNKI and WANFANG(from January 2000 to March 2017).Cohort or case-control studies were identified according to the inclusion and exclusion criteria.Then the quality of the included studies was assessed,and the data was extracted.Meta-analysis was performed by Rev Man 5.3 software.We found select seven cohort study(exposed group 11372 examples,the exposure group,20827 cases)and 24 cases-control study(cases:2516 examples,the control: 2516 cases)from 2967 in the related literature,and calculate the overall risk,overall survival(OS),diseases-free survival(DFS)risk value,and further analysis of FIGO staging,and Grade classification,not pregnant,reduce tumor surgery history,organization type and have a clear connection between endometriosis.Results Analyzing the cohort study and case-control study found that although endometriosis can increased the risk of ovarian cancer(RR,1.24;95% CI,1.14 1.35),EAOC had higher overall survival rate than non-EAOC(HR,0.76;95% CI,0.640.89),the progression-free survival rate has no obvious difference between EACO and non-EAOC(HR,0.81;95% CI,0.48 1.38).The cohort studies and case-control study results have no obvious difference.FIGO stage I to stage II,Grade level 1cancer and nulliparity were much more common in EAOC(risk respectively: RR,1.77;95% CI,1.67 to 1.88;RR,2.05;95% CI,1.49 to 2.82;RR,1.46;95% CI,1.062.01),whereas probability of optimal debulking surgery was a little different between the two groups.(RR,1.16;95% CI,1.04 1.30).In addition,clear cell and endometrioid carcinomas were more common in EAOC(RR,2.41;95% CI,1.17 to3.29;RR,1.55;95% CI,1.27 1.91),whereas and mucinous and serous ovarian cancer were less frequent in EAOC than in non-EAOC(RR,0.41;95% CI,0.31 to0.56;RR,0.58;95% CI,0.42 0.80),cohort studies and case-control study results have no obvious difference.Conclusion Endometriosis is strongly related to the occurrence of ovarian tumors,endometriosis may increase the risk of ovarian cancer.EAOC usually shows favourable characteristics including early-stage disease,low-grade disease and specific histology such as clear cell and endometrioid carcinoma.As EAOC have higher progression-free survival rate and overall survival rate than non-EAOC,we deduce that the endometriosis may not affect the disease procession and prognosis of ovarian cancer.