| Aim: Conservative surgery is currently the main treatment for ovarian endometriosis,but it is easy to relapse after surgery.Repeated surgery will increase the risks of ovarian dysfunction,pelvic organ adhesion,injury and infertility.Our thesis studied the recurrence of ovarian endometriosis patients after laparoscopic conservative surgery,compared the clinical data of patients with and without recurrence,the expression differences of epithelial-mesenchymal transition(EMT)related markers,estrogen receptor and progesterone receptor in their tissues,and explored the factors affecting the recurrence of ovarian endometriosis after surgery.Materials and Methods: We searched the database in our center for patients who received surgical treatments in in Xiamen Maternal and Child Health Hospital and the First Affiliated Hospital of Xiamen University between January 2012 and December 2016.The patients met the inclusion criteria and kept complete paraffin sections and tissues at the same time.According to whether there was recurrence after operation,they were divided into recurrence group(n=77)and non-recurrence group(n=431).We then evaluated the clinical data of the two groups,through single factor and multivariate logistic regression statistical analysis to find out the related factors for postoperative recurrence of endometriosis.At the same time,we use q RT-PCR and immunohistochemistry to detect the expression of EMT-related markers,estrogen receptors and progesterone receptor in two groups of lesion tissue.Results: 1.Among 508 patients in total,77 cases recurred,the recurrence rate was about 15.2%.The recurrence rate in 1-2 years after surgery was significantly higher than that in later years.2.There was no significant difference between the two groups in blood group,BMI,,HE4,CA199,menstrual period,right cyst proportion,maximum cyst diameter,multiple cysts or not(P>0.05).3.Singer factor analysis showed that the risk factors of recurrence included: young menarche age,short menstrual cycle,fewer pregnancies,long period of dysmenorrhea,high CA125,high AMH,left cyst ratio,bilateral cyst ratio,combined adenomyosis,high r-AFS stage;Compared with other age groups,patients younger than or equal to 25 years old have the highest postoperative recurrence rate;the protective factors of recurrence included: age>35 years old,postoperative use of Gn RH-a,postoperative pregnancy(P<0.05).4.Multivariate logistic regression analysis showed that bilateral cysts(or=1.822),uterine adenomyosis(or=1.664),high CA125(or=1.027),high r-AFS stage(stage Ⅲ: or=5.808,stage Ⅳ: or=8.008)were the risk factors for recurrence,age>35 years(or=0.320),postoperative medication(Gn RH-a)(course 4-6: or=0.353),and postoperative pregnancy(or =0.536)were the protective factors for recurrence(P<0.05).5.When the cut-off value of CA125 is 92.1u/ml,the best diagnostic sensitivity is 72.34%,and the diagnostic specificity is 81.42%.There was a significant positive correlation between CA125 and adenomyosis(P<0.05).6.The results of immunohistochemistry showed that the expression of E-cadherin and keratin18 in the recurrent group was lower than that in the non recurrent group,while the expression of vimentin and N-cadherin in the recurrent group was higher(P<0.05).Furthermore,we found that the expression of slug,Snail2,ZEB1 and twist were increased in relapsed patients.7.The expression of slug m RNA in the relapsed group was significantly higher than that in the non relapsed group(P<0.05);the expression of Snail2,ZEB1 / 2,twist m RNA in the two groups was not significant(P>0.05).8.Immunohistochemistry results showed that the expression of ERαand PR was higher in the relapsed group than that in the non relapsed group,while the expression of ERβ was lower in the relapsed group.Conclusion: 1.Bilateral cysts,combined with adenomyosis,high CA125 and high r-AFS staging are the risk factors for the recurrence of ovarian endometriosis after conservative surgery.Age>35 years old,postoperative medication(Gn RH-a)and pregnancy are the protective factors for the recurrence of ovarian endometriosis after conservative surgery.2.The patients with ovarian endometriosis whose age is less than 25 years old have the highest risk of recurrence after operation,so we should arrange the operation time in particular.3.Patients with high CA125 are prone to relapse after operation.When CA125 is greater than 92.1u/ml,it suggests that the risk of recurrence after conservative operation is increased,and more active measures should be taken to prevent recurrence.4.There was a positive correlation between the degree of epithelial-mesenchymal transition and the risk of recurrence.5.The high expression of ERα and low expression of ERβ,PR are expected to be biomarkers to indicate the recurrence of conservative surgery in patients with endometriosis. |
