| ObjectiveTo retrospectively analyze the clinicopathological characteristics and prognostic differences between endometriosis-associated ovarian cancer(EAOC)and non-endometriosis-associated ovarian cancer(non-EAOC),and summarize the clinical characteristics of EAOC and the prognosis of ovarian cancer related factors.Provide a certain reference value for the prevention,early diagnosis,standardized treatment and improvement of prognosis of EAOC in the future.Materials and MethodsThis study collected clinical data of 78 patients who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 and were diagnosed pathologically as clear cell carcinoma and ovarian endometrioid adenocarcinoma.According to Sampson and Scott’s diagnostic criteria for endometriosis-related ovarian cancer,it is divided into endometriosis-related ovarian cancer(EAOC)group and non-endometriosis-related ovarian cancer(non-EAOC)group,the clinical data mainly include name,hospital number,age of onset,age at menarche,menopausal status,pregnancy and parity,main clinical manifestations,past history,imaging examination results of the first admission(such as pelvic color Doppler ultrasound,abdominal CT,MRI Or PECT-CT),serological tumor markers cancer antigen 125(CA125)and human epididymal protein 4(HE4),operation time,name of operation,intraoperative conditions(tumor diameter,lesions involved unilateral and bilateral,residual lesion diameter,ascites,Pelvic adhesions,lymph node metastasis),pathological type,pathological staging(FIGO staging),degree of tissue differentiation,postoperative treatment and review and follow-up.SPSS 23.0 statistical software is used for data analysis.Measurement data conforming to the normal distribution are expressed as mean±standard deviation(x±s),and the independent sample t test is used for the comparison between groups;the median is used for the non-normal distribution,and the rank sum test is used for the comparison between groups.The adoption rate or composition ratio(%)of count data was expressed,and the chi-square test was used for comparison between groups.The Kaplan-Meier method was used for univariate survival analysis and the survival curve was drawn,and the COX proportional hazard regression model was used for multivariate analysis.All statistical tests are two-sided tests,and the test level isα=0.05,and P<0.05 is considered as statistically significant.ResultsAccording to the diagnostic criteria of Sampson and Scott,among 78 study subjects,27 cases were included in the EAOC group and 51 cases were included in the non-EAOC group.A comparative analysis of the EAOC group and the non-EAOC group showed that:1.Age and menstrual status:The average age of onset of the EAOC group(45.11±7.885 years)is lower than the average age of onset of the non-EAOC group(51.000±14.753 years);the average age of menarche(13.30±1.235 years)in the EAOC group is lower than the non-EAOC group The average age at menarche in the EAOC group(14.78±1.901 years);the rate of dysmenorrhea in the EAOC group was higher than that in the non-EAOC group(33.3%vs 9.8%);the rate of non-menopause at onset in the EAOC group was higher than that in the non-EAOC group The premenopausal rate(63.0%vs 31.4%).The difference between the two groups was statistically significant(P=0.01,P=0.019,P=0.01,P=0.007).2.Birth history:The average pregnancy times(2.26±1.534 times)in the EAOC group was lower than the average pregnancy times in the non-EAOC group(3.18±1.493 times),but the difference was not statistically significant(P=0.453);the average in the EAOC group The parity(1.11 ±0.751 times)was lower than the average parity of the non-EAOC group(2.14±1.256 times),and the difference was statistically significant(P=0.028).3.Tumor markers CA125 and HE4:78 patients underwent preoperative CA125 level detection.In the EAOC group,17 patients(63.0%)were within the normal range,with an average value of(173.57±236.368)U/mL;non-In the EAOC group,42 patients(82.4%)were within the normal range,with an average value of(306.99±496.112)U/mL,and the difference between the two groups was not statistically significant(P=0.058、P=0.064).In the EAOC group,24 patients underwent preoperative HE4 level detection,16 patients(66.7%)with HE4 level within the normal range,and the average value of HE4 was(109.10±92.622)pmol/L;there were 46 patients in the non-EAOC group undergoing surgery Before the detection of HE4 levels,25 cases(51.0%)had HE4 levels within the normal range,with an average value of(149.97±104.986)pmol/L,and there was no statistically significant difference between the two groups(P=0.321、P=0.503).4.Main clinical manifestations:There was no statistical significance in abdominal pain(P=0.516),physical examination or palpation and abdominal mass(P=0.099),abdominal distension(P=1.000),vaginal bleeding or fluid(P=0.818).Among them,the highest proportion of abdominal pain in the EAOC group was 40.7%,and in the non-EAOC group,the highest proportion of abdominal masses found or palpated by physical examination was 48.0%.There was a statistically significant difference in the history of combined infertility(P=0.032)and endometriosis(P=0.007).5.Pathological characteristics:EAOC group and non-EAOC group had statistical significance in pathological staging(P<0.001),ascites(P=0.032),lymph node metastasis(P=0.026),and histological type(P=0.722),EAOC group and non-EAOC group had not statistical significant in degree of differentiation(P=0.686),tumor diameter(P=0.447),unilateral and bilateral lesions(P=0.830),residual lesions(P=0.406),pelvic adhesions(P=0.687),tumor recurrence(P=0.098).The proportion of clear cell carcinoma(63.0%,58.8%)in the two groups was higher than that of endometrioid adenocarcinoma.The pathological stage of the EAOC group is earlier than that of the non-EAOC group.EAOC is mainly early(stage I+II),and non-EAOC is mainly advanced(stage III+IV).The tissue differentiation grades of the two groups are all highly differentiated Mainly(66.7%,56.9%).6.Prognosis:The median follow-up time in this study was 61.0 months.The median survival time of the EAOC group was 77.2 months,and the median survival time of the non-EAOC group was 60.5 months.The prognosis of the EAOC group was significantly better than that of the non-EAOC group(χ2=11.337,P=0.001).The median progression-free survival time in the EAOC group was 66.0 months,the median progression-free survival time in the non-EAOC group was 42.0 months,the 5-year survival rate in the EAOC group was 81.5%,and the 5-year survival rate in the non-EAOC group was 52.0%,the difference was statistically significant(P=0.008)7.Factors affecting the prognosis of ovarian cancer:In univariate survival analysis,EMT malignant transformation(χ2=11.337,P=0.02),lesion side(χ2=9.906,P=0.002),pathological stage(χ2=55.952,P<0.001),lymph node metastasis(χ2=45.580,P<0.001),residual disease(χ2=14.281,P<0.001),tumor recurrence(χ2=29.110,P<0.001)have an impact on the prognosis of ovarian cancer.In COX multivariate analysis,EMT malignant transformation(χ2=5.285,P=0.022)and pathological stage(χ2=11.379,P=0.001)were independent factors affecting the prognosis of ovarian cancer.Conclusion1.EAOC has the characteristics of an earlier age of onset,an earlier FIGO stage,and a better prognosis.2.EMT malignant transformation,unilateral and bilateral lesions,pathological staging,lymph node metastasis,residual lesions,and tumor recurrence are important factors affecting the prognosis of ovarian cancer.EMT malignant transformation and pathological stage are independent factors affecting the prognosis of ovarian cancer,and EMT malignancy becomes a protective factor,and pathological staging is a risk factor. |
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