Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case–control studies

Abstract

SummaryBackgroundEndometriosis is a risk factor for epithelial ovarian cancer; however, whether this risk extends to all invasive histological subtypes or borderline tumours is not clear. We undertook an international collaborative study to assess the association between endometriosis and histological subtypes of ovarian cancer.MethodsData from 13 ovarian cancer case–control studies, which were part of the Ovarian Cancer Association Consortium, were pooled and logistic regression analyses were undertaken to assess the association between self-reported endometriosis and risk of ovarian cancer. Analyses of invasive cases were done with respect to histological subtypes, grade, and stage, and analyses of borderline tumours by histological subtype. Age, ethnic origin, study site, parity, and duration of oral contraceptive use were included in all analytical models.Findings13 226 controls and 7911 women with invasive ovarian cancer were included in this analysis. 818 and 738, respectively, reported a history of endometriosis. 1907 women with borderline ovarian cancer were also included in the analysis, and 168 of these reported a history of endometriosis. Self-reported endometriosis was associated with a significantly increased risk of clear-cell (136 [20·2%] of 674 cases vs 818 [6·2%] of 13 226 controls, odds ratio 3·05, 95% CI 2·43–3·84, p<0·0001), low-grade serous (31 [9·2%] of 336 cases, 2·11, 1·39–3·20, p<0·0001), and endometrioid invasive ovarian cancers (169 [13·9%] of 1220 cases, 2·04, 1·67–2·48, p<0·0001). No association was noted between endometriosis and risk of mucinous (31 [6·0%] of 516 cases, 1·02, 0·69–1·50, p=0·93) or high-grade serous invasive ovarian cancer (261 [7·1%] of 3659 cases, 1·13, 0·97–1·32, p=0·13), or borderline tumours of either subtype (serous 103 [9·0%] of 1140 cases, 1·20, 0·95–1·52, p=0·12, and mucinous 65 [8·5%] of 767 cases, 1·12, 0·84–1·48, p=0·45).InterpretationClinicians should be aware of the increased risk of specific subtypes of ovarian cancer in women with endometriosis. Future efforts should focus on understanding the mechanisms that might lead to malignant transformation of endometriosis so as to help identify subsets of women at increased risk of ovarian cancer.FundingOvarian Cancer Research Fund, National Institutes of Health, California Cancer Research Program, California Department of Health Services, Lon V Smith Foundation, European Community's Seventh Framework Programme, German Federal Ministry of Education and Research of Germany, Programme of Clinical Biomedical Research, German Cancer Research Centre, Eve Appeal, Oak Foundation, UK National Institute of Health Research, National Health and Medical Research Council of Australia, US Army Medical Research and Materiel Command, Cancer Council Tasmania, Cancer Foundation of Western Australia, Mermaid 1, Danish Cancer Society, and Roswell Park Alliance Foundation.

The role of fertility preservation in patients with endometriosis

“…As such, endometriosis should also be recognized as an indication for FPT: patients with endometriosis-related symptoms, like pelvic pain or the presence of ovarian cysts, frequently undergo extensive pelvic surgery involving the ovaries [9]. The need for surgery and histological evaluation is also justified by recent studies indicating an increased risk for malignancy in patients suffering from endometriosis when large or rapidly growing endometriomas are detected or when suspicious changes in sonographic appearance occur [10].…”

Napsin A is a specific marker for ovarian clear cell adenocarcinoma

“…Ovarian clear cell adenocarcinoma is often associated with endometriosis, 18,19 and we have recently shown that stress caused by excess iron leads to amplification of the Met gene and carcinogenesis in the ovary. 20,21 Compared with serous adenocarcinoma, clear cell adenocarcinoma is resistant to standard platinum-based chemotherapy; 22 thus, survival rates in patients with advanced stages of ovarian clear cell adenocarcinoma are poor.…”

A new classification of ovarian tumors

“…Пограничные серомуцинозные опухоли ранее отно-сились к эндоцервикальному варианту пограничных му-цинозных опухолей яичника, сейчас вместе с эндоме-триоидными карциномами и светлоклеточными карци-номами составляют группу «опухолей, развивающихся из эндометриоза» [11]. Важнейшим звеном патогенеза этих новообразований является инактивирующая мута-ция ARID1А -гена-супрессора опухолевого роста, ко-дирующего белок BAF250a комплекса SWI-SNF-A, уча-ствующего в ремоделировании хроматина [12].…”