Increased Association Between Endometriosis and Endometrial Cancer

Abstract

ObjectiveAssociation between endometriosis and ovarian cancer has been well established. Nonetheless, endometriosis may also be associated with endometrial cancer because of shared etiological mechanisms of both estrogen stimulation and chronic inflammation; however, the association between these 2 disorders has rarely been investigated.MethodsThe National Health Insurance Research Databases in Taiwan were retrieved and analyzed. The case cohort consisted of patients with a diagnosis of endometriosis between January 1997 and December 2000 (N = 15,488). For the construction of control cohort, 8 age- and sex-matched control patients for every patient in the case cohort were selected using a random sampling method (n = 123,904). All subjects were tracked for 10 years from the date of entry to identify whether they had developed endometrial cancer. The Cox proportional hazards regression model was used to evaluate 10-year event occurrence of endometrial cancer.ResultsDuring the 10-year follow-up period, 392 participants developed endometrial cancer, with 104 (0.7%) distributed in the case cohort and 288 (0.2%) in the control cohort. Multivariable Cox regression modeling demonstrates a higher risk for developing endometrial cancer in the case cohort than in the control cohort (adjusted hazard ratio [aHR], 2.83; 95% confidence interval [CI], 1.495.35; P < 0.01). Age at diagnosis of endometriosis shows a moderator effect: when 40 years or younger, the risk for developing endometrial cancer was comparable between the case cohort and the control cohort (aHR, 1.42; 95% CI, 0.55–3.70; P = 0.226), whereas when older than 40 years, the risk for developing endometrial cancer was higher in the former group than in the latter group (aHR, 7.08; 95% CI, 2.33–21.55; P = 0.007).ConclusionsPatients diagnosed with endometriosis may harbor an increased risk for developing endometrial cancer in their later life. Closer monitoring is advised for this patient population.

Endometriosis — insights into a multifaceted entity

“…Since then, numerous studies have demonstrated the overlap of definition criteria of malignant phenotype with those of endometriosis. Results of meta-analyses revealed their increased association [204,205].…”

“…The significance of borderline tumors is currently regarded as a part of endometriosis-associated ovarian carcinoma spectrum [206,214,215]. Moreover, recent evidences indicate that patients with endometriosis have a significant risk for endometrial cancer, mainly endometrioid and clear cell subtypes [220].…”

Does Endometriosis Impact the Prognosis of Endometrial Cancer?

“…Nearly 30% of the simultaneous cases were reported to harbor endometriosis. [4][5][6] Both endometriosis and endometrial cancer have the same origin; they have an identical molecular profile and etiological mechanisms such as chronic inflammation and the estrogen effect. Therefore, it is possible that endometriosis might affect the risk and prognosis of endometrial cancer.…”

“…Therefore, it is possible that endometriosis might affect the risk and prognosis of endometrial cancer. 4,[7][8][9] Despite these facts, due attention has not been given to the endometriosis-endometrial cancer association. To the best of our knowledge, no study in the literature has discussed the impact of endometriosis on the prognosis of endometrial cancer.…”

Discrimination of malignant transformation from benign endometriosis using a near‑infrared approach

“…The pathogenesis of ovarian cancer is complex, and is affected by numerous epigenetic and genetic factors (2). Endometriosis is usually a benign disorder, but is associated with an increased risk for developing ovarian (3) and endometrial cancers (4). Endometrioid and clear cell carcinoma of the ovary (endometriosis-associated ovarian cancer, EAOC) originates from endometriosis.…”