Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis.
Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis.
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DOI：
10.1038/bjc.2014.29
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发表时间：
2014-04-02
影响因子：
8.8
通讯作者：
Song, Y. S.
中科院分区：
文献类型：
--
作者：
Kim, H. S.;Kim, T. H.;Chung, H. H.;Song, Y. S.
子宫内膜异位症女性患卵巢癌的风险和预后尚未得到很好的确定。因此，我们研究了子宫内膜异位症对卵巢癌风险和预后的影响，并比较了子宫内膜异位症相关卵巢癌（EAOC）与非EAOC的临床病理特征。在检索了1990年1月至2012年12月期间在线发表的相关研究后，我们找到了20项病例对照研究和15项队列研究，包括来自1625项潜在相关研究的444255名患者。meta分析中，采用风险比（RR）或标准发病率比（SIR）评价子宫内膜异位症的卵巢癌风险及临床病理特征，采用95%可信区间（CI）的风险比（HR）评价预后。采用Higgins I2评估异质性，选择固定效应（I2≥50%）或随机效应模型（I2≥50%），采用Egger检验的漏斗图未发现发表偏倚（P < 0.05）。此外，我们根据研究设计、子宫内膜异位症评估、组织学、疾病状态、研究质量和对潜在混杂因素的调整进行了亚组分析，以尽量减少偏倚。在病例对照或两组队列研究（RR, 1.265; 95% CI, 1.214-1.318）和单组队列研究（SIR, 1.797; 95% CI, 1.276-2.531）中，子宫内膜异位症增加了卵巢癌的风险，这在亚组分析中是相似的。虽然无进展生存期在EAOC和非EAOC之间没有差异（HR, 1.023; 95% CI, 0.712-1.470），但在粗分析中，EAOC与非EAOC的总生存期相关（HR, 0.778; 95% CI, 0.655-0.925）。然而，在亚组分析中，两组的无进展生存期和总生存期没有差异。I-II期疾病、1级疾病和不孕在EAOC中更为常见（RRs分别为1.959、1.319和1.327；95% CI分别为1.367 ~ 2.807、1.149 ~ 1.514和1.245 ~ 1.415），而两组最佳减肿手术的概率无差异（RR为1.403；95% CI为0.915 ~ 2.152）。此外，子宫内膜样癌和透明细胞癌在EAOC中更常见（RRs分别为1.759和2.606；95% CI分别为1.551-1.995和2.225-3.053），浆液性癌在EAOC中比在非EAOC中更少见（RR, 0.733; 95% CI, 0.617-0.871），两组间发生黏液性癌的风险无差异（RR, 0.805; 95% CI, 0.584-1.109）。这些临床病理特征在亚组分析中也相似。子宫内膜异位症与卵巢癌风险增加密切相关，EAOC表现出包括早期疾病、低级别疾病和特定组织学（如子宫内膜样癌或透明细胞癌）在内的有利特征。然而，子宫内膜异位症可能不会影响卵巢癌发病后的疾病进展。
The risk and prognosis of ovarian cancer have not been well established in women with endometriosis. Thus, we investigated the impact of endometriosis on the risk and prognosis for ovarian cancer, and evaluated clinicopathologic characteristics of endometriosis-associated ovarian cancer (EAOC) in comparison with non-EAOC. After we searched an electronic search to identify relevant studies published online between January 1990 and December 2012, we found 20 case–control and 15 cohort studies including 444 255 patients from 1 625 potentially relevant studies. In the meta-analysis, ovarian cancer risk by endometriosis and clinicopathologic characteristics were evaluated using risk ratio (RR) or standard incidence ratio (SIR), and prognosis was investigated using hazard ratio (HR) with 95% confidence interval (CI). Heterogeneity was evaluated using Higgins I2 to select fixed-effect (I2 ⩽50%) or random effects models (I2>50%), and found no publication bias using funnel plots with Egger's test (P>0.05). Furthermore, we performed subgroup analyses based on study design, assessment of endometriosis, histology, disease status, quality of study and adjustment for potential confounding factors to minimise bias. Endometriosis increased ovarian cancer risk in case–control or two-arm cohort studies (RR, 1.265; 95% CI, 1.214–1.318) and single-arm cohort studies (SIR, 1.797; 95% CI, 1.276–2.531), which were similar in subgroup analyses. Although progression-free survival was not different between EAOC and non-EAOC (HR, 1.023; 95% CI, 0.712–1.470), EAOC was associated with better overall survival than non-EAOC in crude analyses (HR, 0.778; 95% CI, 0.655–0.925). However, progression-free survival and overall survival were not different between the two groups in subgroup analyses. Stage I–II disease, grade 1 disease and nulliparity were more common in EAOC (RRs, 1.959, 1.319 and 1.327; 95% CIs, 1.367–2.807, 1.149–1.514 and 1.245–1.415), whereas probability of optimal debulking surgery was not different between the two groups (RR, 1.403; 95% CI, 0.915–2.152). Furthermore, endometrioid and clear cell carcinomas were more common in EAOC (RRs, 1.759 and 2.606; 95% CIs, 1.551–1.995 and 2.225–3.053), whereas serous carcinoma was less frequent in EAOC than in non-EAOC (RR, 0.733; 95% CI, 0.617–0.871), and there was no difference in the risk of mucinous carcinoma between the two groups (RR, 0.805; 95% CI, 0.584–1.109). These clinicopathologic characteristics were also similar in subgroup analyses. Endometriosis is strongly associated with the increased risk of ovarian cancer, and EAOC shows favourable characteristics including early-stage disease, low-grade disease and a specific histology such as endometrioid or clear cell carcinoma. However, endometriosis may not affect disease progression after the onset of ovarian cancer.
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细胞周期基因和卵巢癌易感性：tagSNP 分析。
影响因子：
8.8
作者：
Cunningham, J. M.;Vierkant, R. A.;Sellers, T. A.;Phelan, C.;Rider, D. N.;Liebow, M.;Schildkraut, J.;Berchuck, A.;Couch, F. J.;Wang, X.;Fridley, B. L.;Gentry-Maharaj, A.;Menon, U.;Hogdall, E.;Kjaer, S.;Whittemore, A.;DiCioccio, R.;Song, H.;Gayther, S. A.;Ramus, S. J.;Pharaoh, P. D. P.;Goode, E. L.
通讯作者：
Goode, E. L.
DOI：
10.1038/nrc2644
发表时间：
2009-06
期刊：
Nature reviews. Cancer
影响因子：
--
作者：
通讯作者：
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影响因子：
6.2
作者：
del Carmen, MG;Sehdev, AES;Bristow, RE
通讯作者：
Bristow, RE
影响因子：
7.5
作者：
Kato, N;Sasou, S;Motoyama, T
通讯作者：
Motoyama, T
DOI：
10.1016/s0002-9378(97)70550-7
发表时间：
1997-03-01
影响因子：
9.8
作者：
Brinton, LA;Gridley, G;Bergqvist, A
通讯作者：
Bergqvist, A