Impact of endometriosis on risk of ovarian, endometrial and cervical cancers: a meta-analysis

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This meta-analysis of 25 studies found that endometriosis is associated with a significantly increased risk of ovarian cancer, but not endometrial or cervical cancer.

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This paper conducted a meta-analysis of 25 qualified observational studies (16 cohort and 9 case–control) assessing whether women with endometriosis have different risks of ovarian, endometrial, and cervical cancers, using a comprehensive literature search and random-effects models with risk ratios (RR), and study quality evaluated with the Newcastle–Ottawa Scale. The pooled results showed increased risk of ovarian cancer among patients with endometriosis (RR 1.964; 95% CI 1.685 to 2.290), while endometriosis was not necessarily associated with higher endometrial cancer risk (RR 1.176; 95% CI 0.878 to 1.575) and was not associated with increased cervical cancer risk (RR 0.670; 95% CI 0.537 to 0.838). A key limitation noted in such pooled observational evidence is that underlying differences across included studies and designs may affect the estimates, which is partially addressed through the random-effects approach. This paper is centrally about endometriosis — it meta-analyzes how endometriosis influences risk for ovarian, endometrial, and cervical cancers.

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Abstract

PURPOSE: The risks of gynecologic cancer have not been well established in women with endometriosis. The objective of the present study was to investigate the influence of endometriosis on the risk for three gynecologic cancer (ovarian cancer, endometrial cancer and cervical cancer). METHODS: We gathered updated evidence about the risk relationship between endometriosis and gynecologic cancers by conducting a comprehensive search of several medical literature electronic databases, including PubMed, Embase and the Cochrane Library. The design and quality of all studies were evaluated using the Newcastle-Ottawa Scale (NOS), and a random-effects model was used to calculate pooled risk ratio (RR). RESULTS: Of the 8538 articles our search produced, we selected 25 qualified studies, including 16 cohort studies and 9 case-control studies. Patients with endometriosis had both an increased risk of ovarian cancer [RR  1.964; 95% CI (1.685, 2.290)]. The risk of endometrial cancer (EC) is not necessarily higher in patients with endometriosis [RR 1.176, 95% CI (0.878, 1.575)]. Endometriosis was not associated with an increased risk for cervical cancer (CC) [RR 0.670, 95% CI (0.537, 0.838)]. CONCLUSIONS: Patients with endometriosis need to be closely observed and rechecked regularly to prevent malignant changes.
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Abstract

Purpose The risks of gynecologic cancer have not been well established in women with endometriosis. The objective of the present study was to investigate the influence of endometriosis on the risk for three gynecologic cancer (ovarian cancer, endometrial cancer and cervical cancer).

Methods

We gathered updated evidence about the risk relationship between endometriosis and gynecologic cancers by conducting a comprehensive search of several medical literature electronic databases, including PubMed, Embase and the Cochrane Library. The design and quality of all studies were evaluated using the Newcastle–Ottawa Scale (NOS), and a random-effects model was used to calculate pooled risk ratio (RR).

Results

Of the 8538 articles our search produced, we selected 25 qualified studies, including 16 cohort studies and 9 case–control studies. Patients with endometriosis had both an increased risk of ovarian cancer [RR 1.964; 95% CI (1.685, 2.290)]. The risk of endometrial cancer (EC) is not necessarily higher in patients with endometriosis [RR 1.176, 95% CI (0.878, 1.575)]. Endometriosis was not associated with an increased risk for cervical cancer (CC) [RR 0.670, 95% CI (0.537, 0.838)].

Conclusions

Patients with endometriosis need to be closely observed and rechecked regularly to prevent malignant changes. Similar content being viewed by others

References

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Acknowledgements

Thanks to all authors who contributed to this article. Author information Authors and Affiliations Contributions Jia Li: select topic, literature search, data extraction and analysis, write the original article. Ruijuan Liu: select topic, literature search, data extraction and analysis, write of the review and editing. Shifeng Tang: data extraction, methodology. Fubin Feng: methodology. Cun Liu: the use of software, statistical analysis. Lu Wang: the use of software, statistical analysis. Wenge Zhao: validate the results, write the original article. Tingting Zhang: write, review, and edit the original article. Yan Yao: write the original article. Xue Wang: literature search. Changgang Sun: select topic, review original article. Corresponding author Ethics declarations Conflict of interest The authors declare to have no conflict of interest. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Electronic supplementary material Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article li, J., Liu, R., Tang, S. et al. Impact of endometriosis on risk of ovarian, endometrial and cervical cancers: a meta-analysis. Arch Gynecol Obstet 299, 35–46 (2019). https://doi.org/10.1007/s00404-018-4968-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-018-4968-1

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endometriosis

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Endometrial Neoplasms Endometriosis Genital Neoplasms, Female Ovarian Neoplasms Uterine Cervical Neoplasms Case-Control Studies Cohort Studies Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometrium Endometrium Female Genital Neoplasms, Female Genital Neoplasms, Female Humans Odds Ratio Ovarian Neoplasms Ovarian Neoplasms Risk

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