Risk Factors Of Endometriosis-associated Ovarian Cancer

Objective: We attempted to study the risk factors of endometriosis-associated ovarian cancer.Method: The study group of the study consisted of fifteen patients who received surgery in First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2020 and were diagnosed with EAOC.The control group was formed by60 patients who received surgery and were diagnosed with ovarian endometriosis during the same period in the same hospital.We sorted out thoroughly their clinical information.A retrospective study was performed to study the clinical and pathological features of EAOC and the risk factors associated with occurrence of EAOC.Result: Among the fifteen EAOC cases,the histopathological types of 9 cases(60%)were clear cell ovarian carcinoma,and 5 cases(33.33%)were ovarian endometrioid carcinoma,1 case(6.67%)was endometrioid ovarian carcinoma combined with clear cell ovarian carcinoma.There were 10 patients(76.92%)with stage I,2 patients with stage II(15.38%),and 1 patient(7.69%)with stage III.Univariate analysis showed that the study control group were significantly older than the control group(41.53 y vs35.83 y,p=0.02).There is no significant difference in age of menarche,menopausal status,gravidity and parity between study group and control group.Compared to control group,more individuals in study group suffered from menstrual disorder,and the difference was significant.The tumors of study group were larger than those of control group,and the difference was of significance(8.77 cm vs 5.97 cm,p=0.03).The proportions in study group of cyst walls thickening,separations enhanced,solid components,blood flow signals strong,ascites,were significantly higher than those in the control group(p<0.01).The levels of HE4,ROMA,and D-dimer in study group were significantly higher than those of the control group(p<0.05),while the levels of CA125,CA72-4,CA199 were parallel in two group.Multivariate analysis showed ROMA was an independent risk factor of EAOC.Conclusion: In patients with endometriosis,if the following condition occurs: ROMA significantly increasing,age larger than 45 y,or menstrual abnormality,cyst larger than 9cm,or imaging findings suggest that the cyst walls are thick,or separations are enhanced,or there are solid components in the mass or strong blood flow signals,ascites,or the levels of HE4,D-dimer significantly increasing,we should pay great attention to these patients and find out malignant transformation to EAOC.