Obiective: To explore the risk factors of endometriosis-associated ovarian cancer (EAOC) in women with ovarian endometriosis aged 45 years and older in China. Methods: The medical records of total 1 038 women aged 45 years and older with a surgicopathological diagnosis of ovarian endometriosis treated at Peking Union Medical College Hospital from December 1994 to December 2014 were reviewed. Histology evaluation determined ovarian endometriosis with (n=30) or without (n=1 008) ovarian cancer. Results: (1) There were 30 (2.9%, 30/1 018) cases confirmed as having EAOC. Clear cell carcinoma (63.3%, 17/30) and endometrioid adenocarcinoma (23.3%, 7/30) were commonly observed subtypes and 70.0% of EAOC patients were at stage Ⅰ. (2) Compared women with ovarian endometriosis in the same age group, patients with EAOC were older (50.8 vs 48.5 years, P=0.002). There were more in postmenopausal status at diagnosis of EAOC (P<0.01). There were more found with a mass ≥8 cm (P<0.01). Women with EAOC had higher prevalence of coexisting endometrial disorders (P=0.003). No differences were found in preoperative CA(125) value and infertile or nulliparous women (P>0.05). Conclusions: For women with ovarian endometriosis aged 45 years and older, the subgroup of patients characterized by postmenopausal status and ovarian endometrioma (≥8 cm) have a higher risk of EAOC. Active intervention or intensive follow-up should be considered for this population group, especially for those concurrent with endometrial disorders.
目的： 探讨45岁以上子宫内膜异位症（内异症）相关卵巢上皮性癌（卵巢癌；EAOC）患者的风险因素。 方法： 收集1994年12月至2014年12月在中国医学科学院北京协和医学院北京协和医院接受手术治疗、年龄≥45岁的1 038例卵巢型内异症患者的临床病理资料，所有患者均经病理检查证实，其中EAOC 30例。回顾性分析EAOC的临床病理特点，并分析影响EAOC发生的相关风险因素。 结果： （1）EAOC的临床病理特点：1 038例卵巢型内异症患者中，EAOC的发生率为2.9%（30/1 038）。30例EAOC患者中，内异症合并卵巢癌13例（43.3%），其中病灶位于不同侧卵巢者6例（20.0%）、位于同侧卵巢者7例（7例，占23.3%）；内异症恶变为卵巢癌17例（56.7%）。EAOC的病理类型主要为卵巢透明细胞癌（19例，占63.3%）和子宫内膜样癌（7例，占23.3%）；手术病理分期多为Ⅰ期（17例，占70.0%）。（2）EAOC的相关因素分析：采用logistic回归法进行单因素分析，结果显示，EAOC的发生与患者年龄、绝经状态、卵巢包块大小、子宫内膜异常情况明显相关（P<0.05），而与孕产次、合并良性妇科疾病情况、术前血清CA(125)水平无关（P>0.05）。 结论： 对于45岁以上的卵巢型内异症患者，绝经后、卵巢包块最大径≥8 cm、合并子宫内膜异常的患者发生EAOC的风险明显增加，需要严密随诊并积极干预。.
Keywords: Age factors; Endometriosis; Ovarian neoplasms; Risk factors.