初治卵巢子宫内膜异位症恶变的危险因素研究

Risk factors of the malignant transformation of untreated ovarian endometriosis

目的:研究子宫内膜异位症(EMs)恶变为上皮性卵巢癌的危险因素。方法:收集2010年1月至2020年3月在南京医科大学第一附属医院就诊并接受手术治疗、术后病理确诊为子宫内膜异位症相关性卵巢癌(EAOC)的15例患者及术后病理诊断为卵巢EMs的60例患者的临床病例资料。回顾分析EAOC的临床病理特点,分析EAOC发生的危险因素。结果:15例EAOC患者中,病理类型为透明细胞癌9例(60.00%),子宫内膜样癌5例(33.33%),子宫内膜样癌合并透明细胞癌1例(6.67%);I期10例(76.92%),II期2例(15.38%),III期1例(7.69%)。EAOC患者合并月经异常的比例高于内异症组,差异有统计学意义(P=0.02),EAOC患者包块大于内异症组,但差异无统计学意义。EAOC患者的囊壁增厚、分隔强化、包块有实性成分、有血流信号、合并腹水、肿瘤累及单侧的比例显著高于内异症组(P<0.01),肿瘤组HE4、ROMA、D-二聚体水平显著高于内异症组(P<0.01),CA125水平无明显差异。结论:EMs患者中合并月经异常或影像学检查提示肿瘤大于8cm,囊壁厚或分隔强化或包块中有实性成分或存在较丰富的血流信号,出现腹水,HE4、D-二聚体水平明显升高,ROMA指数较高,应高度重视,积极完善相关检查,进一步明确有无发生恶变。

Objective:To study the risk factors of the malignant transformation of endometriosis into epithelial ovarian cancer.Method:Fifteen patients diagnosed with endometriosis-related ovarian cancer(EAOC)from January 2010 to March 2020 in the First Affiliated Hospital of Nanjing Medical University and received surgical treatment were chosen,and the clinical informations were sorted out.The control group were 60 patients who received surgical treatment and were diagnosed as ovarian endometriosis(EMs)during the same period.Result:Among the 15 patients with EAOC,the pathological type was 9 cases(60.00%)of clear cell carcinoma,5 cases(33.33%)of endometrioid carcinoma,1 case(6.67%)of endometrioid carcinoma combined with clear cell carcinoma.There were 10 patients(76.92%)with stage I,2 patients with stage II(15.38%),and 1 patient(7.69%)with stage III.The proportion of patient with EAOC who had abnormal menstruation was higher than that of the control group.The difference was statistically significant.The diameter of the mass of EAOC patient was significantly larger than that of control group.The proportion of the thickening of the cyst wall,the enhancement of separation,and the presence of solid components,blood flow signals,ascites,and unilateral tumor involved in EAOC patient were significantly higher than that of the control group.The levels of HE4,ROMA,and D-dimer in EAOC group were significantly higher than those of the endometriosis group,and there was no significant difference between the the level of CA125 of two groups.Conclusion:Among patients with EMs,who should be payed attention to is that those with menstrual abnormality,or diameter of the tumor larger than 8cm,or cyst wall thick,or separation enhanced,or solid component,or blood flow signal rich,or ascites,or level of HE4,D-dimer and ROMA increasing.More examination should be taken to expel malignant transformation of EMs.