子宫内膜异位症的分型与卵巢癌风险。

Endometriosis Typology and Ovarian Cancer Risk.

机构信息

Huntsman Cancer Institute, University of Utah, Salt Lake City.

Department of Population Health Sciences, University of Utah, Salt Lake City.

出版信息

JAMA. 2024 Aug 13;332(6):482-489. doi: 10.1001/jama.2024.9210.

DOI:10.1001/jama.2024.9210

PMID:39018030

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11255975/

Abstract

IMPORTANCE

Endometriosis has been associated with an increased risk of ovarian cancer; however, the associations between endometriosis subtypes and ovarian cancer histotypes have not been well-described.

OBJECTIVE

To evaluate the associations of endometriosis subtypes with incidence of ovarian cancer, both overall and by histotype.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study using data from the Utah Population Database. The cohort was assembled by matching 78 893 women with endometriosis in a 1:5 ratio to women without endometriosis.

EXPOSURES

Endometriosis cases were identified via electronic health records and categorized as superficial endometriosis, ovarian endometriomas, deep infiltrating endometriosis, or other.

MAIN OUTCOMES AND MEASURES

Estimated adjusted hazard ratios (aHRs), adjusted risk differences (aRDs) per 10 000 women, and 95% CIs for overall ovarian cancer, type I ovarian cancer, and type II ovarian cancer comparing women with each type of endometriosis with women without endometriosis. Models accounted for sociodemographic factors, reproductive history, and past gynecologic operations.

RESULTS

In this Utah-based cohort, the mean (SD) age at first endometriosis diagnosis was 36 (10) years. There were 597 women with ovarian cancer. Ovarian cancer risk was higher among women with endometriosis compared with women without endometriosis (aHR, 4.20 [95% CI, 3.59-4.91]; aRD, 9.90 [95% CI, 7.22-12.57]), and risk of type I ovarian cancer was especially high (aHR, 7.48 [95% CI, 5.80-9.65]; aRD, 7.53 [95% CI, 5.46-9.61]). Ovarian cancer risk was highest in women with deep infiltrating endometriosis and/or ovarian endometriomas for all ovarian cancers (aHR, 9.66 [95% CI, 7.77-12.00]; aRD, 26.71 [95% CI, 20.01-33.41]), type I ovarian cancer (aHR, 18.96 [95% CI, 13.78-26.08]; aRD, 19.57 [95% CI, 13.80-25.35]), and type II ovarian cancer (aHR, 3.72 [95% CI, 2.31-5.98]; aRD, 2.42 [95% CI, -0.01 to 4.85]).

CONCLUSIONS AND RELEVANCE

Ovarian cancer risk was markedly increased among women with ovarian endometriomas and/or deep infiltrating endometriosis. This population may benefit from counseling regarding ovarian cancer risk and prevention and could be an important population for targeted screening and prevention studies.

摘要

重要性

子宫内膜异位症与卵巢癌风险增加相关；然而，子宫内膜异位症亚型与卵巢癌组织类型之间的关联尚未得到很好的描述。

目的

评估子宫内膜异位症亚型与卵巢癌总体及组织类型发病风险的关系。

设计、设置和参与者：利用犹他州人口数据库中的数据进行基于人群的队列研究。该队列通过将 78893 名患有子宫内膜异位症的女性与 1:5 的比例相匹配的女性进行匹配来组建，这些女性没有子宫内膜异位症。

暴露

通过电子健康记录识别子宫内膜异位症病例，并分为浅表性子宫内膜异位症、卵巢子宫内膜瘤、深部浸润性子宫内膜异位症或其他。

主要结果和措施

估计每 10000 名女性中患有每种子宫内膜异位症的女性与无子宫内膜异位症的女性相比，总体卵巢癌、I 型卵巢癌和 II 型卵巢癌的调整后危险比（aHR）、调整后风险差异（aRD）和 95%置信区间。模型考虑了社会人口因素、生育史和既往妇科手术。

结果

在这项基于犹他州的队列研究中，首次诊断子宫内膜异位症的平均（SD）年龄为 36（10）岁。有 597 名女性患有卵巢癌。与无子宫内膜异位症的女性相比，患有子宫内膜异位症的女性患卵巢癌的风险更高（aHR，4.20[95%CI，3.59-4.91]；aRD，9.90[95%CI，7.22-12.57]），I 型卵巢癌的风险尤其高（aHR，7.48[95%CI，5.80-9.65]；aRD，7.53[95%CI，5.46-9.61]）。对于所有卵巢癌（aHR，9.66[95%CI，7.77-12.00]；aRD，26.71[95%CI，20.01-33.41]）、I 型卵巢癌（aHR，18.96[95%CI，13.78-26.08]；aRD，19.57[95%CI，13.80-25.35]）和 II 型卵巢癌（aHR，3.72[95%CI，2.31-5.98]；aRD，2.42[95%CI，-0.01 至 4.85]），患有深部浸润性子宫内膜异位症和/或卵巢子宫内膜瘤的女性患卵巢癌的风险最高。