| Objective: To analyze the general data,clinical manifestation,auxiliary examination,treatment and prognosis of ovarian endometriosis(EMs)malignancy,summarize the clinical features of ovarian EMs malignant transformation,and explore the related factors of ovarian EMs malignant transformation and prognosis.Objective to find out the predictive and prognostic markers of ovarian EMs malignant transformation in order to early diagnosis,early treatment,prolong survival time and improve the quality of life of patients.Method: A total of 564 patients with ovarian EMs were enrolled in Tianjin Center Obstetrics and Gynecology Hospital from 2010 to 2015.Among them,113 cases of ovarian EMs malignant transformation were the study group,451 cases of ovarian EMs patients without malignant change were the control group.All the clinical data and follow-up of the two groups were analyzed retrospectively.The risk factors and prognostic factors of EMs malignant transformation were elucidated by multivariate analysis.Result: 1?The average age of patients in the study group than in the control group,the average age of first sexual life compared with the control group,the average age of marriage was larger than the control group,the average duration than in the control group,the average BMI index compared with the control group,the proportion of mental workers was higher than the control group,the proportion of manual workers is lower than the control group.The study group menopause,the proportion of patients with dysmenorrhea were higher than the control group.Patients in the study group than in the control group the number of abortion,cesarean section rate was higher than that in control group,delivery ratio is lower than the control group,the number of production more than that in the control group.Two groups of patients with the above indexes were statistically significant(p<0.05).Non conditional Logistic regression analysis showed that the age of marriage,the number of production factors the course,BMI index is 4 main factors that affect ovarian malignant EMs.2?The study group and the control group of patients with clinical manifestations of abdominal pain was the highest,followed by the palpable abdominal mass,sexual pain,infertility,irregular vaginal bleeding,no symptoms.Study group of patients with abdominal pain,palpable abdominal mass were also higher than that of control group,and the difference was statistically significant(p<0.05).According to the clinical stage of cancer,will I,II as mild group(87 cases),III,IV as severe group(26 cases).Patients with severe abdominal pain,pain during intercourse,the rate of infertility than mild group,the differences were statistically significance(p<0.05).3?The patients in the study group had the most cystic and solid mixing(40.7%),and the diameter of >8cm was about 34.5%.The mass of 50.4% patients in the six months increased rapidly.All specimens were detected atypical endometrial glandular epithelial atypical or nuclear atypia changes.In the control group,90% cases were cystic,and the diameter of was >8cm,and the mass of 14.4% the patients in the six months increased rapidly,and atypical or nuclear atypia was found in the 28 cases.4 ?The average value of HE4 in the study group was 134.67±18.56 pmol/L,and the mean value of the control group was 75.32±9.4 pmol/L;The average value of CA199 in the study group was 63.78±11.89 IU/ml,the mean value of the control group was 4.61± 9.35 IU/ml;The average value of CA125 in the study group was 89.5 ± 57.31 IU/ml,and the average value of the control group was 63.8±14.4 IU/ml,and the difference was statistically significant(P < 0.05).The levels of HE4,CA199 and CA125 in patients with stage ?,?,? and ? were statistically different(p <0.05).5?The patients in the study group were followed up for an average of 37.6 months(6-72 months).2 cases of recurrence after 1 year,11 cases of recurrence within 3 years,26 cases of recurrence within 5 years,7 cases of death,of which 5 cases died of postoperative recurrence.The 1 year survival rate was 99.4%,3 year survival rate of 96.8%,and the 5 years survival rate was 92.8%.Clinical stage,histological type and chemotherapy are the 3 main factors influencing the prognosis of patients with malignant EMs.Conclusion:1?The patients with ovarian EMs were more common in women of childbearing age,and the proportion of symptoms and symptom complexity of patients with malignant transformation was higher than that of the patients without malignant transformation,and were related to clinical stage.The clinical stage was higher,the symptoms was more complex.2?Late marriage age,less production times,long course of disease,and BMI are the risk factors of ovarian EMs malignant transformation.3?Comprehensive clinical symptoms,medical history,pathological examination,serum HE4,CA199,CA125 and imaging examination can effectively improve the diagnosis and differential diagnosis of ovarian EMs malignant transformation.4?Clinical stage,histological type and chemotherapy are the factors that influence the prognosis of patients with malignant EMs. |
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