Does the Presence of Endometriosis Affect Prognosis of Ovarian Cancer?

Abstract

Objective To characterize ovarian cancers associated with endometriosis and to evaluate the prognostic impact of endometriosis. Methods Ovarian cancer cases from a single institution diagnosed between 2000 and 2013 were examined and specimens reviewed by two pathologists for the presence of endometriosis. Ovarian cancer cases with and without endometriosis were compared to determine the clinical factors associated with endometriosis and the prognostic significance of endometriosis. Two-sample T-tests, Chi-square tests, multivariable logistic regression, and Cox proportional hazards models were used for statistical analysis. Results Among 139 epithelial ovarian cancers diagnosed between 2000 and 2013, there were 49 (35%) with endometriosis and 90 (65%) without endometriosis. The distribution of histologies of ovarian cancers with endometriosis was 43% endometrioid, 23% clear cell, 20% mixed, 8% mucinous, and 6% serous. Endometriosis associated ovarian cancers were more likely to be confined to the pelvis (54% vs. 9%, p<0.0001) and of lower tumor grade (51% vs. 29%, p=0.014). Younger age and earlier stage independently predicted the presence of endometriosis (p=0.0011 and p<0.0001, respectively). Ovarian cancer patients with endometriosis had improved PFS and OS [(HR=0.20; 95% CI, 0.09–0.43), (HR=0.18; 95% CI, 0.04–0.81)], compared to patients without endometriosis. After controlling for tumor stage and age, endometriosis was not an independent predictor of survival. Conclusions Patients with ovarian cancer and endometriosis are younger with lower stage and grade, and disease confined to the pelvis compared to patients without endometriosis. Ovarian cancers with endometriosis have improved PFS and OS; however endometriosis had no independent prognostic significance in our study.

Distinct molecular pathways in ovarian endometrioid adenocarcinoma with concurrent endometriosis

“…While large amounts of genomic data have been generated based on histotype, there is limited information regarding the molecular contribution of the endometriotic tumor microenvironment on OEA. While this subtle pathologic diagnosis is often overlooked in research studies, the improvement of outcomes of women with endometriosis at time of ovarian cancer staging is not . Therefore, the molecular contributions of the endometriotic tumor microenvironment may affect the overall tumor biology.…”

“…While this subtle pathologic diagnosis is often overlooked in research studies, the improvement of outcomes of women with endometriosis at time of ovarian cancer staging is not. [7][8][9] Therefore, the molecular contributions of the endometriotic tumor microenvironment may affect the overall tumor biology.…”

“…The presence of endometriosis, itself a benign disease, increases the risk of ovarian endometrioid and clear‐cell adenocarcinoma up to 8.9‐fold, depending on genetic admixture and environmental exposures . Clinically, studies suggest that co‐occurrence of endometriosis with ovarian cancer is associated with an improved prognosis . Although Dr. John Sampson first hypothesized the malignant potential of endometriosis in 1925, the relationship between endometriosis and ovarian cancer remains being deciphered.…”

“…[4][5][6] Clinically, studies suggest that co-occurrence of endometriosis with ovarian cancer is associated with an improved prognosis. [7][8][9] Although Dr. John Sampson first hypothesized the malignant potential of endometriosis in 1925, 10 the relationship between endometriosis and ovarian cancer remains being deciphered. Previous reports have identified a limited number of oncogenes or tumor suppressors that may be involved in the pathogenesis of OEA.…”

Clinical implication for endometriosis associated with ovarian cancer

“… 11 A study that included 139 patients with epithelial ovarian cancer (49 with endometriosis and 90 without endometriosis) showed that patients with EAOC were younger, and more likely confined to the pelvis (54% vs. 9%) and at lower grade (51% vs. 29%) at diagnosis compared with patients with non-EAOC. 31 Current reports on the survival outcome of EAOC were basically comparing the survival differences between EAOC and non-EAOC patients. In a metaanalysis on 20 case–control and 15 cohort studies that included 444,255 patients reported that there were no differences in progression free survival (PFS) (HR, 1.023), but a slightly better overall survival (OS) by crude analyses (HR, 0.778) in EAOC than non-EAOC.…”