Kadan Yfat, Fiascone Stephen, McCourt Carolyn, Raker Chris, Granai C O, Steinhoff Margaret, Moore Richard G
Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States.
Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States.
Eur J Obstet Gynecol Reprod Biol. 2015 Feb;185:23-7. doi: 10.1016/j.ejogrb.2014.11.029. Epub 2014 Dec 2.
To determine predictive factors for the presence of malignant transformation in ovarian endometriotic cysts.
This was an IRB approved, case control study analyzing patient data from 2004 to 2013. Pathology database records were searched to identify patients with benign endometrioma and ovarian carcinoma arising in the background of endometriosis. Inclusion criteria required each patient to have a preoperative diagnosis of adnexal mass and no other findings concerning for malignancy. Patient clinical records were queried for preoperative symptoms, serum CA125 levels and radiologic findings. Pathologic data were collected including histology, tumor grade and stage.
A total of 138 patients met inclusion criteria; 42 women with ovarian cancer arising in the background of endometriosis and 96 women with benign endometrioma. Women diagnosed with ovarian cancer were significantly older than women with endometriosis (53.6 vs. 39.2 years). There was no difference in presence of symptoms between the two groups. Women with malignant tumors were found to have significantly larger cysts (14 cm vs. 7.5 cm; p<0.0001) that were more often multilocular (45.7% vs. 12.2%; p<0.0001), and contained solid components (77.1% vs. 14.5%; p<0.0001). Among patients that were observed prior to surgery there was a significant difference in the change in size of the mass over time with 4.2 cm increase for cases vs. 1.0 cm increase for controls (p=0.02). Multiple logistic regression analysis indicated that for every 5 years increase in age there was an adjusted OR of 2.17 (p=0.003). An age of 49 years or greater had an 80.6% sensitivity (95% CI: 62.5-92.5%) and an 82.9% specificity (95% CI: 67.9-92.8%) for malignancy, and solid component on imaging had an adjusted OR of 23.7 (p<0.0001). Serum CA125 levels tended to be higher in patients with malignant tumors but did not reach statistical significance with a mean of 204.9 vs. 66.9 (p=0.1).
Significant predictors for malignant transformation of endometriosis include cyst characteristics and age. Women above the age of 49 with multilocular cysts and solid components are at high risk for malignant transformation of endometriosis. Serum CA125 level is not a significant predictor of malignant transformation.
确定卵巢子宫内膜异位囊肿发生恶性转化的预测因素。
这是一项经机构审查委员会批准的病例对照研究，分析了2004年至2013年的患者数据。检索病理数据库记录，以识别在子宫内膜异位背景下发生的良性子宫内膜瘤和卵巢癌患者。纳入标准要求每位患者术前诊断为附件包块，且无其他恶性相关发现。查询患者临床记录以获取术前症状、血清CA125水平和影像学检查结果。收集病理数据，包括组织学、肿瘤分级和分期。
共有138例患者符合纳入标准；42例在子宫内膜异位背景下发生卵巢癌的女性和96例患有良性子宫内膜瘤的女性。诊断为卵巢癌的女性明显比患有子宫内膜异位的女性年龄大（53.6岁对39.2岁）。两组症状出现情况无差异。发现患有恶性肿瘤的女性囊肿明显更大（14厘米对7.5厘米；p<0.0001），更常为多房性（45.7%对12.2%；p<~0.0001），且含有实性成分（77.1%对14.5%；p<0.0001）。在术前观察的患者中，肿块大小随时间的变化有显著差异，病例组增加4.2厘米，对照组增加1.0厘米（p=0.02）。多因素逻辑回归分析表明，年龄每增加5岁，校正后的比值比为2.17（p=0.003）。年龄49岁及以上对恶性肿瘤的敏感性为80.6%（95%可信区间：62.5-92.5%），特异性为82.9%（95%可信区间：67.9-92.8%），影像学上的实性成分校正后的比值比为23.7（p<0.0001）。恶性肿瘤患者的血清CA125水平往往较高，但未达到统计学意义，平均值分别为204.9和66.9（p=0.1）。
子宫内膜异位恶性转化的重要预测因素包括囊肿特征和年龄。年龄49岁以上、有多房囊肿和实性成分的女性发生子宫内膜异位恶性转化的风险较高。血清CA125水平不是恶性转化的重要预测指标。
