卵巢子宫内膜异位症与卵巢恶性肿瘤的相关性分析

目的卵巢子宫内膜异位症（EM）是常见的妇科良性疾病,具有潜在的恶变可能。本研究通过对卵巢EM恶变、合并EM及未合并EM的卵巢恶性肿瘤病例的分析,了解卵巢EM恶变与卵巢恶性肿瘤的关系。方法 回顾性分析新疆医科大学第一附属医院2003年1月至2010年12月经病理确诊的原发性卵巢恶性肿瘤患者共362例,根据卵巢EM恶变诊断标准及病理结果,将EM恶变的17例患者分为A组,其他仅合并卵巢EM的卵巢恶性肿瘤16例患者分为B组,未合并卵巢EM的卵巢恶性肿瘤329例为C组,从卵巢恶性肿瘤的临床病理资料对三组进行对照分析。同期在本院经手术确诊的卵巢EM患者共1 946例。结果A、B组临床症状多以腹痛为主,其次为盆腔包块;从临床分期来看,A、B组以Ⅱ期居多,分别占70.6%、56.5%,C组以Ⅲ期为多,占47.7%;从组织类型来看,A、B组多为透明细胞癌（分别为70.6%、56.2%）,而C组则以浆液性腺癌（50.2%）为主。三组在一般特征、临床分期及病理组织分类的分布差异均有统计学意义。结论卵巢EM恶变的临床症状以腹痛为多,其次为盆腔包块,肿块直径超过9 cm,且CA125水平多在200 U/ml以上;卵巢EM恶变及卵巢恶性肿瘤合并EM病例中早期患者比例较高,具有年轻化（尤其是卵巢内异症恶变患者）的特点,且多为卵巢透明细胞癌和子宫内膜样癌;卵巢EM恶变的诊断与组织病灶程度、临床分期可能有关,卵巢EM病灶恶变可能来源于透明细胞癌和子宫内膜样癌,因此卵巢EM可被认为是卵巢恶性肿瘤的危险因素。

Analysis of the relationship between endometriosis and ovarian cancer

Objective To explore the relationship between ovarian cancer and endometriosis by analyzing the cases of ovary cancer with endometriosis.Methods 362 patients with primary ovarian cancer between January 2003 and December 2010 were analyzed retrospectively.Among the 362 cases,17 originated from endometriosis(group A),16 were found to have CO-existing ovarian endometriosis(group B),and the remaining 329 had no ovarian endometriosis at all(group C).Results The incidence of stage Ⅱ in group A and group B was 70.6% and 56.2%,and incidence of stage Ⅲ in group C was 47.7%.All three groups had a subtype of serious carcinoma.ConclusionsThe diagnosis of malignant change of endometriosis may be associated with the degree and classification of ovary cancer.Patients of endometriosis-associated epithelial ovarian carcinoma,especially patients with tumors arising from endometriosis,were found to be younger,having a better survival and were mostly diagnosed with the subtype of clear-cell and endometrio-carcinoma.There is a compact relationship between endometriosis and ovarian cancer,especially clear cell carcinoma and endometrio-carcinoma.Endometriosis causes a high risk for ovarian cancer.