Risk Factors for Recurrence of Ovarian Endometriosis in Chinese Patients Aged 45 and Over

Background： When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using ofgonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis （EM） in patients aged 45 and over. Methods： This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1：4 as the nonrecurrence group （ 180 patients in total）. Stratified Cox regression was used to analyze the risk factors of the recurrence. Results： Univariate analysis showed that there was a significant difference in the postoperative treatment （the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, x2=4.729, P = 0.030） and ovarian preservation （the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group. 25.0 % vs. 44.4%, x2 = 19.462, P 〈 0.001 ） between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient＇s age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions （such as myoma and adenomyoma） and endometrial abnormalities, and surgical approach or surgical staging （all P 〉 0.05）. Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM （odds ratio： 5.594, 95% confidence interval： 1.919-16.310, P= 0.002）. Conclusion： Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.

Expression and correlation of pyroptosis-related markers and PI3K/AKT pathway in endometriosis

Objective:The expression of pyroptosis related factors GSDMD,Caspase-1,NLRP3,IL-1β,IL-18 and PI3K/AKT signaling pathways in ovarian endometriosis was investigated and their correlations analyzed.Methods:A total of 50 patients with endometriosis who underwent ovarian cystectomy in the Department of Gynecology,the First Affiliated Hospital of Bengbu Medical College from January 2022 to January 2023 were enrolled as endometriosis group.In addition,55 patients with normal endometrial tissue who underwent hysteroscopic surgery in the hospital during the same period were selected as the control group,and patients with endometriosis were excluded during the operation.RT-qPCR,Western Blot was used to detect the expression of pyroptosis-related factor and PI3K/AKT signaling pathway mRAN,protein in the above tissues,and the correlation between the expression of the two was analyzed by Pearson correlation test.Results:The expression of pyroptosis-related factors and mRAN of PI3K/AKT signaling pathway in ectopic ovarian cyst tissues was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that pyroptosis-related factors in ectopic ovarian cysts were positively correlated with the mRNA expression levels of PI3K/AKT signaling pathway(P<0.05).Conclusion:The pyroptosis correlation factors GSDMD,Caspase-1,NLRP3,IL-1β,IL-18 and PI3K/AKT signaling pathways are highly expressed in ovarian endometriosis,and the pyroptosis-related factors are positively correlated with the expression of PI3K/AKT signaling pathway,suggesting that the regulation of endometriosis by activating the PI3K/AKT signaling pathway is likely to be achieved by activating the PI3K/AKT signaling pathway.