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

Abstract

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 of gonadotropin-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%, χ2 = 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%, χ2 = 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.

The recurrence rate of ovarian endometrioma in women aged 40–49 years and impact of hormonal treatment after conservative surgery

“…Two previous studies reported the recurrence rates of ovarian endometrioma in women aged 40-49 years. He et al reported that the cumulative recurrence rate was 10.0% at 1 year and 27% at 5 years after surgery in patients aged 45 years higher, and that the risk of recurrence was reduced with post-operative treatment and increased by ovarian preservation 9 . However, this study included oophorectomized patients and used a different definition of recurrence, as not only sonographic findings but also recurrent pain symptoms and elevated serum CA125 level were considered as signs of disease recurrence 9 .…”

“…Various medical conditions such as hypertension, diabetes mellitus, thromboembolic disease, cardiovascular problems, and osteoporosis are more frequent in this group than in younger women. Moreover, no age-based drug administration guidelines exist, and few studies have investigated the recurrence rate of ovarian endometrioma in women aged 40–49 years or differences in recurrence rates according to post-operative medication 9 , 10 .…”

Status and related factors of postoperative recurrence of ovarian endometriosis: a cross-sectional study of 874 cases

“…Some studies found other possible risk factors that influencing the recurrence of endometrioma. Ovarian preservation was an independent risk factor for postoperative recurrence of endometrioma over 45 years old [ 35 ]. The depth of endometrial tissue infiltration into the cyst wall was a risk factor for endometrioma recurrence, and the optimal cut-off value was 1.2 mm, at which time the sensitivity was 62.9% and the specificity was 75% [ 36 ].…”

Height and pelvic lesion number: Do they have a positive relationship with postoperative recurrence in adolescent endometriosis?—A retrospective clinical analysis of 89 adolescent endometriosis in China

“…Ultrasonography was used to determined postsurgical EMs recurrence. Recurrent endometrioma was defined as the presence of ovarian cyst (≥2 cm in diameter) that has a thin wall and homogenous low echogenic fluid signal, the cyst does not disappear after several menstrual cycles in ultrasound 13 . The patients will perform pelvic magnetic resonance imaging if the ovarian mass was not typical on ultrasound.…”