摘要目的 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1038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:1038例卵巢型内异症患者中,EAOC的发生率为2.9%(30/1038).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CA125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.

abstractsObiective 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 1038 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=1008) ovarian cancer. Results (1) There were 30 (2.9%, 30/1018) 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 stageⅠ. (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 CA125 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.