| Objective: To explore the clinical characteristics,case types and pathogenesis of ovarian cancer associated with endometriosis,in order to improve the understanding of ovarian cancer associated with endometriosis,and to provide some clinical data for the diagnosis,treatment and improvement of prognosis.Method: This study collected 99 cases of ovarian clear cell carcinoma and ovarian endometrial carcinoma patients,which were diagnosed and hospitalized in the First Bethune Hospital of Jilin University,from December 2010 to December 2017,according to whether merger of endometriosis the patients are divided into two groups,endometriosis-associated ovarian cancer group(EAOC group)and nonendometriosis-associated ovarian cancer group(non-EAOC group).By comparing the differences in age,the menstruation and fertility situation,clinical characteristics,tumor size,tumor markers,intraoperative situation,pathological results,postoperative chemotherapy and chemotherapy drug resistance between the two groups,the purpose of this study was to understand the features of endometriosis associated ovarian cancer,and analyze the prognosis factors of endometriosisassociated ovarian cancer.The complete follow-up data of patients was processed by SPSS 23.0 analysis softwar.The measurement data conforming to the normal distribution were expressed as :(?x±s),and the comparison between the two groups was conducted by T test.?2 tests or Fisher's exact test were used for Count data.Kaplan-meier method was used for univariate survival analysis,and drawing survival curves.Log-rank test was used to test whether there were differences in survival curves of different groups.The multivariate survival analysis was achieved through the application of Cox regression method.P<0.05 was defined as significant statistically.Results:1.The age of research group in the study was 30~69 years old,with an average of(47.14±9.59)years old;the age of the control group was 29~75 years old,with an average age of(51.99±9.76)years old.The age of onset in the research group was earlier than that in the control group,and the difference was statistically significant(P< 0.05).Compared with the control group,more patients in the study group were in the state of non-menopause,more likely to be associated with dysmenorrhea,and the differences were statistically significant(P < 0.05).There was no significant difference in the number of pregnancy between the two groups(P > 0.05).2.Abdominal distension and pain are the main clinical manifestations in both the research group and the control group,accounting for 62.0% and 51.4%,respectively.There was no significant difference in clinical manifestations between the two groups(P >0.05).3.The mean tumor diameter of the patients in the study group was(12.01±3.75)cm.The mean tumor diameter of the patients in the control group was(12.14 3.22)cm.There was no significant difference in tumor diameter between the two groups(P > 0.05).4.The preoperative serum tumor markers CA125,CA199 and HE4 in the two groups were divided into two groups with 200U/ml,27 u /ml and 150 p M as the boundaries.Compared with the control group,the CA125 level in the study group was lower than that in the control group,and the difference was statistically significant(P < 0.001).The CA199 positive rate of patients in the two groups was significantly higher than that in the control group(P < 0.05).The positive rate of HE4 in the two groups was significantly higher than that in the control group(P < 0.05).5.Intraoperative comparison between the two groups of patients: most of the tumors in the study group occurred in the unilateral ovary,and the difference was statistically significant(P < 0.05).In the study group,26 cases(89.66%)were in early FIGO staging(?+ ?period),3 patients(10.34%)were in late FIGO staging(+ period)? ?.In the control group,42 cases(60.00%)were in early FIGO staging(?+ ?period),28 cases(40.00%)were in late FIGO staging(?+ ?period).Compared with the control group,there were more patients in the early FIGO staging in the study group,the difference was statistically significant(P < 0.05).In the study group,16 patients underwent pelvic lymph node dissection at the same time,and 1 patient had lymphatic metastasis,with a metastasis rate of 6.25%(1/16).Pelvic lymph node dissection was performed in 51 patients in the control group at the same time,among which 9 patients had lymphatic metastasis,with a metastasis rate of 17.64%(9/51).Comparison of lymphatic metastasis between the two groups showed that the lymphatic metastasis rate in the study group was lower than that in the control group,and the difference was not statistically significant(P>0.05).Among the patients in the study group,there was 1 case that its sum of the diameter of postoperative residual lesions ? 1cm,with a surgical satisfaction rate of 96.6%(28/29).In the control group,there ware 3 case that the sum of the diameter of postoperative residual lesions ? 1cm,with a surgical satisfaction rate of 95.7%(67/70).There was no statistically significant difference in the surgical satisfaction rate between the two groups(P > 0.05).6.The comparative analysis of pathological results : there were 19 cases of ovarian clear cell carcinoma(65.52%)and 10 cases of ovarian endometrioid carcinoma(34.48%)in the study group,and,37 cases of ovarian clear cell carcinoma(52.86%)and 33 cases of ovarian endometrioid carcinoma(47.14%)in the control group.The proportion of ovarian clear cell carcinoma in the study group was higher than that in the control group,and the difference was no statistically significant(P > 0.05).In the pathological results of the study group,there were 12 cases of ER positive patients,with a positive rate of 66.67%;in the control group,there were 16 cases of ER positive patients,with a positive rate of 61.54%;in the study group,there were 6 cases of PR positive patients,with a positive rate of 33.33%;in the control group,there were 7 cases of PR positive patients,with a positive rate of 26.92%.In the study group,there were 15 patients with positive P53,and the positive rate was 83.33%;in the control group,there were 20 patients with positive P53,and the positive rate was 76.92%.There was no statistical difference in ER,PR,and P53 expression rate between the two groups(P > 0.05).7.The comparative analysis of drug resistance and recurrence: there were 3 patients in the study group showed drug resistance,and the drug resistance rate was 10.34%.there were 7 patients in the control group,and showed drug resistance rate was was 10.00%.There was no statistically significant difference in drug resistance rate between the two groups(P > 0.05).The recurrence rate of 13 patients in the study group was 44.8%,and that of 37 patients in the control group was 52.9%.The recurrence rate of the patients in the study group was slightly lower than that of the control group,and the difference was not statistically significant(P > 0.05).8.In univariate survival analysis of Log Rank test,the factors related to prognosis of EAOC were age,preoperative CA125 and HE4 levels,size of surgical residual lesions,FIGO stage,lymph node metastasis,expression of PR and P53,postoperative recurrence,and chemotherapy resistance.Among them,patients aged 47 years old,preoperative CA125 ?200 U/ml,preoperative positive HE4,surgical residual lesions ?1cm,the late FIGO stage,positive lymphatic metastasis,PR negative,P53 positive,postoperative recurrence,and chemotherapy resistance had poor prognosis.The survival curves of patients in each group were compared,and the differences were statistically significant(P < 0.05).9.In multivariate survival analysis of COX multivariate regression analysis showed that age ?47 years old(HR:9.161,95% CI:1.014-82.785)and preoperative CA125 level ? 200U/ml(HR: 6.035,95% CI:1.044-34.907)were independent risk factors of endometria-associated ovarian cancer.Conclusions: 1.Endometriosis-associated ovarian cancer is a special cancer with low age of onset,early tumor stage,low recurrence rate and good prognosis,and its main pathological type was clear cell carcinoma.2.For patients with endometriosis,if gynecological ultrasonography indicates solid part of the tumor,color ultrasonography indicates rich blood flow,cyst diameter greater than 8cm,or tumor with small diameter but increase rapidiy in a short period of or even rupture,preoperative CA125 level above 200U/ml,should be highly aware ofthe possibility of endometria-related ovarian cancer,and MRI should be performed if necessary to exclude the diagnosis.3.In univariate survival analysis of Log Rank test,the factors related to prognosis of EAOC were age,preoperative CA125 and HE4 levels,size of surgical residual lesions,FIGO stage,lymph node metastasis,expression of PR and P53,postoperative recurrence,and chemotherapy resistance.Among them,patients aged 47 years old,preoperative CA125 ?200 U/ml,preoperative positive HE4,surgical residual lesions ?1cm,the late FIGO stage,positive lymphatic metastasis,PR negative,P53 positive,postoperative recurrence,and chemotherapy resistance had poor prognosis.The survival curves of patients in each group were compared,and the differences were statistically significant(P < 0.05).4.In multivariate survival analysis of COX multivariate regression analysis showed that age ?47 years old(HR:9.161,95% CI:1.014-82.785)and preoperative CA125 level ? 200U/ml(HR: 6.035,95% CI:1.044-34.907)were independent risk factors of endometria-associated ovarian cancer. |
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