Gynecological Surgery and Endometriosis Departmental Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, and Università degli Studi, Milano, Italy.
Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Italy.
Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:151-168. doi: 10.1016/j.bpobgyn.2018.01.017. Epub 2018 Feb 15.
In women with endometriosis, the lifetime risk of ovarian cancer is increased from 1.4% to about 1.9%. The risk of clear cell and endometrioid ovarian cancer is, respectively, tripled and doubled. Atypical endometriosis, observed in 1-3% of endometriomas excised in premenopausal women, is the intermediate precursor lesion linking typical endometriosis and clear cell/endometrioid tumors. Prolonged oral contraceptive use is associated with a major reduction in ovarian cancer risk among women with endometriosis. Surveillance ± progestogen treatment or surgery should be discussed in perimenopausal women with small, typical endometriomas. In most perimenopausal women with a history of endometriosis but without endometriomas, surveillance instead of risk-reducing bilateral salpingo-oophorectomy seems advisable. Risk-reducing salpingo-oophorectomy might benefit patients at particularly increased risk, but the evidence is inconclusive. Risk profiling models and decision aids may assist patients in their choice. Screening of the general perimenopausal population to detect asymptomatic endometriomas is unlikely to reduce disease-specific mortality.
在患有子宫内膜异位症的女性中，卵巢癌的终生风险从 1.4%增加到约 1.9%。透明细胞癌和子宫内膜样卵巢癌的风险分别增加了两倍和两倍。在绝经前切除的子宫内膜瘤中观察到的不典型子宫内膜异位症是将典型子宫内膜异位症和透明细胞/子宫内膜样肿瘤联系起来的中间前体病变。长期口服避孕药的使用与子宫内膜异位症女性的卵巢癌风险显著降低有关。对于绝经前、有小的典型子宫内膜瘤的女性，应讨论监测+孕激素治疗或手术。对于大多数有子宫内膜异位症病史但无子宫内膜瘤的绝经前女性，监测而不是降低风险的双侧输卵管卵巢切除术似乎是明智的。降低风险的输卵管卵巢切除术可能对风险特别高的患者有益，但证据尚无定论。风险分析模型和决策辅助工具可以帮助患者做出选择。对一般围绝经期人群进行筛查以检测无症状子宫内膜瘤不太可能降低疾病特异性死亡率。
