45岁及以上子宫内膜异位症相关卵巢上皮性癌的风险因素分析

Risk factors of endometriosis associated ovarian carcinoma in women aged 45 years and older

目的探讨45岁以上子宫内膜异位症（内异症）相关卵巢上皮性癌（卵巢癌；EAOC）患者的风险因素。方法收集1994年12月至2014年12月在中国医学科学院北京协和医学院北京协和医院接受手术治疗、年龄≥45岁的1 038例卵巢型内异症患者的临床病理资料，所有患者均经病理检查证实，其中EAOC 30例。回顾性分析EAOC的临床病理特点，并分析影响EAOC发生的相关风险因素。结果（1）EAOC的临床病理特点：1 038例卵巢型内异症患者中，EAOC的发生率为2.9%（30/1 038）。30例EAOC患者中，内异症合并卵巢癌13例（43.3%），其中病灶位于不同侧卵巢者6例（20.0%）、位于同侧卵巢者7例（7例，占23.3%）；内异症恶变为卵巢癌17例（56.7%）。EAOC的病理类型主要为卵巢透明细胞癌（19例，占63.3%）和子宫内膜样癌（7例，占23.3%）；手术病理分期多为Ⅰ期（17例，占70.0%）。（2）EAOC的相关因素分析：采用logistic回归法进行单因素分析，结果显示，EAOC的发生与患者年龄、绝经状态、卵巢包块大小、子宫内膜异常情况明显相关（P〈0.05），而与孕产次、合并良性妇科疾病情况、术前血清CA125水平无关（P〉0.05）。结论对于45岁以上的卵巢型内异症患者，绝经后、卵巢包块最大径≥8 cm、合并子宫内膜异常的患者发生EAOC的风险明显增加，需要严密随诊并积极干预。

ObiectiveTo explore the risk factors of endometriosis-associated ovarian cancer （EAOC） in women with ovarian endometriosis aged 45 years and older in China.MethodsThe medical records of total 1 038 women aged 45 years and older with a surgicopathological diagnosis of ovarian endometriosis treated at Peking Union Medical College Hospital from December 1994 to December 2014 were reviewed. Histology evaluation determined ovarian endometriosis with （n=30） or without （n=1 008） ovarian cancer.Results（1） There were 30 （2.9%, 30/1 018） cases confirmed as having EAOC. Clear cell carcinoma （63.3%, 17/30） and endometrioid adenocarcinoma （23.3%, 7/30） were commonly observed subtypes and 70.0% of EAOC patients were at stage Ⅰ. （2） Compared women with ovarian endometriosis in the same age group, patients with EAOC were older （50.8 vs 48.5 years, P=0.002）. There were more in postmenopausal status at diagnosis of EAOC （P〈0.01）. There were more found with a mass ≥8 cm （P〈0.01）. Women with EAOC had higher prevalence of coexisting endometrial disorders （P=0.003）. No differences were found in preoperative CA125 value and infertile or nulliparous women （P〉0.05）.ConclusionsFor women with ovarian endometriosis aged 45 years and older, the subgroup of patients characterized by postmenopausal status and ovarian endometrioma （≥8 cm） have a higher risk of EAOC. Active intervention or intensive follow-up should be considered for this population group, especially for those concurrent with endometrial disorders.