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Original research
Endometriosis-associated ovarian cancer: a different clinical entity
  1. Umberto Leone Roberti Maggiore1,
  2. G Bogani1,
  3. Biagio Paolini2,
  4. Fabio Martinelli1,
  5. Giulia Chiarello3,
  6. Ludovica Spanò Bascio4,
  7. Valentina Chiappa1,
  8. Simone Ferrero5,6,
  9. Antonino Ditto1 and
  10. Francesco Raspagliesi1
    1. 1Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    2. 2Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    3. 3Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
    4. 4Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
    5. 5Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
    6. 6Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
    1. Correspondence to Dr Umberto Leone Roberti Maggiore, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy; ulrm{at}me.com

    Abstract

    Objective To compare survival outcomes and patterns of recurrence between endometriosis-associated ovarian cancer patients and non-endometriosis-associated ovarian cancer patients.

    Methods This retrospective study included data of consecutive patients with endometrioid or clear cell ovarian cancer treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano between January 2010 and June 2021. Patients were assigned to one of two groups according to the absence or presence of endometriosis together with ovarian cancer at final histological examination. Survival outcomes were assessed using Kaplan-Meier and Cox hazard models. Proportions in recurrence rate and pattern of recurrence were evaluated using the Fisher exact test.

    Results Overall, 83 women were included in the endometriosis-associated ovarian cancer group and 144 in the non-endometriosis-associated ovarian cancer group, respectively. Patients included in the non- endometriosis-associated ovarian cancer group had a shorter disease-free survival than those in the endometriosis-associated ovarian cancer group (23.4 (range 2.0–168.9) vs 60.9 (range 4.0–287.8) months; p<0.001). Univariable and multivariable analyses showed that the association with endometriosis, previous hormonal treatment, early stage at presentation, and endometrioid histology were related to better disease-free survival in the entire study population. Similarly, patients in the non-endometriosis-associated ovarian cancer group had a shorter median (range) overall survival than those in the endometriosis-associated ovarian cancer group (54.4 (range 0.7–190.6) vs 77.6 (range 4.5–317.8) months; p<0.001). Univariable and multivariable analyses showed that younger age at diagnosis, association with endometriosis, and early stage at presentation were related to better overall survival. The recurrence rate was higher in the non-endometriosis-associated ovarian cancer group (63/144 women, 43.8%) than in the endometriosis-associated ovarian cancer group (17/83 women, 20.5%; p<0.001).

    Conclusions Endometriosis-associated ovarian cancer patients had significantly longer disease-free survival and overall survival than non-endometriosis-associated ovarian cancer patients, while the recurrence rate was higher in non-endometriosis-associated ovarian cancer patients.

    • ovarian cancer
    • ovarian diseases
    • surgery
    • surgical oncology

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2023-005139

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Twitter @ulrm82, @DrFMartinelli

      • Contributors ULRM: study concept and design, data analysis and interpretation, statistical analysis, manuscript preparation and editing, guarantor. GB: quality control of data, manuscript review. BP: expert pathologist who reviewed all cases included in the study, manuscript review. FM: surgeon involved in surgical treatment of the patients, manuscript review. GC: data acquisition, quality control of the data, manuscript preparation. LSB: data acquisition, quality control of the data, manuscript preparation. VC: expert sonographer who evaluated the cases, manuscript review. SF: data acquisition, manuscript review. AD: surgeon involved in surgical treatment of the patients, manuscript review. FR: study concept, surgeon involved in surgical treatment of the patients, manuscript review.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.