Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data

Abstract

ObjectiveThe objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data.MethodsThe study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated.ResultsA total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p<0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p<0.05). The validated C-index was 0.69.ConclusionFor a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.

<p>Ovarian cancer in the world: epidemiology and risk factors</p>

“…The relationship between endometriosis and ovarian cancer has been shown in various studies through various mechanisms. The results of a cohort study showed that, in people with endometrium, aging, living in urban areas, low or high income, depression, pelvic infection, and lack of childbearing increase the risk of ovarian cancer 68. In 1925, Sampson69 proposed a link between endometriosis and ovarian cancer based on the theory of malignant changes of endometriosis.…”

Comprehensive characterization of endometrial competing endogenous RNA network in infertile women of childbearing age

“…However, the pathogenesis of endometriosis is not fully clarified. In general, it is widely accepted that endometriosis could be induced by various factors, and pelvic inflammation has been identified as a prerequisite for the occurrence of endometriosis [25]. With the development of transcriptomics, recent studies confirmed the essential role of different subtypes of RNAs in endometriosis, and a set of well-studied RNAs, including mRNAs, lncRNAs, and miRNAs, had been identified as crucial regulators of endometriosis.…”

Endometriosis and gynaecological cancers: molecular insights behind a complex machinery

“…More detailed studies tried to elucidate the reasons behind these contradictory results. An evaluation of 200,000 patients showed that higher risk is associated with greater age, pelvic inflammatory problems, and being childless [38]. A retrospective study of malignancy risks in endometriosis found than not only ovarian cancer, but also cervical, breast, and thyroid cancer have higher incidence [39].…”