Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Nara, Japan.
Int J Clin Oncol. 2009 Oct;14(5):378-82. doi: 10.1007/s10147-009-0931-2. Epub 2009 Oct 25.
We review whether endometriosis-associated ovarian cancer is a specific entity compared with ovarian cancer not associated with endometriosis, with respect to epidemiology, natural history, and clinical diagnosis; we present a review of the English-language literature for ovarian cancer in endometriosis with respect to these three features. A recent prospective study in Japan directly showed that, during a follow-up of up to 17 years of an ovarian endometrioma cohort (n = 6398), 46 incident ovarian cancers were identified, showing that the ovarian cancer risk was significantly elevated in patients with ovarian endometrioma (standardized incidence ratio [SIR], 8.95; 95% confidence interval [CI], 4.12 to 15.3). Advancing age (>40 years) and the size of the endometriomas (>9 cm) were independent predictors of the development of ovarian cancer among the women with ovarian endometrioma. Although some endometriosis lesions may predispose to clear cell carcinoma (CCC) and endometrioid adenocarcinoma (EAC) of the ovary, both of these cancers differ from the other histological types with respect to their clinical characteristics and carcinogenesis. In patients with endometriosis-associated ovarian cancer, benign-appearing ovarian masses are typically present several years before the diagnosis of the cancer. A slightly elevated carbohydrate antigen [CA] 125 level is also typically present many years before the diagnosis in these patients. However, serous-type ovarian cancer may exhibit a rapid progression possibly through de-novo carcinogenesis. Ovarian endometrioma could be viewed as a neoplastic process, particularly in perimenopausal women. Understanding the mechanisms of the development of endometriosis and elucidating its pathogenesis and pathophysiology are intrinsic to the prevention of endometriosis-associated ovarian cancer and the search for effective therapies.
我们回顾了子宫内膜异位症相关卵巢癌与非子宫内膜异位症相关卵巢癌在流行病学、自然史和临床诊断方面是否存在差异；我们回顾了英语文献中关于子宫内膜异位症相关卵巢癌的这些特征。最近在日本进行的一项前瞻性研究直接表明，在对一个卵巢子宫内膜异位症瘤队列（n=6398）进行长达 17 年的随访中，发现了 46 例卵巢癌病例，表明卵巢子宫内膜异位症患者的卵巢癌风险显著升高（标准化发病比 [SIR]，8.95；95%置信区间 [CI]，4.12 至 15.3）。年龄增长（>40 岁）和子宫内膜异位症瘤的大小（>9 厘米）是卵巢子宫内膜异位症患者发生卵巢癌的独立预测因素。尽管一些子宫内膜异位症病变可能导致卵巢透明细胞癌（CCC）和子宫内膜样腺癌（EAC），但与其他组织学类型相比，这两种癌症在临床特征和癌变方面存在差异。在子宫内膜异位症相关卵巢癌患者中，良性卵巢肿块通常在癌症诊断前几年出现。这些患者的 CA125 水平也通常在多年前就略有升高。然而，浆液性卵巢癌可能表现为快速进展，可能通过从头发生癌变。卵巢子宫内膜异位症瘤可以被视为一种肿瘤过程，尤其是在围绝经期妇女中。了解子宫内膜异位症发生的机制，阐明其发病机制和病理生理学，对于预防子宫内膜异位症相关卵巢癌和寻找有效的治疗方法至关重要。
