Endometriosis-associated Ovarian Cancer, from Risk Factors to Survival Rate: A Systematic Review and Meta-Analysis

Elham Askary, Saeed Alborzi, Kefayat Chamanara, Alimohammad Keshtvarz Hesam Abadi
2025 · doi:10.30476/mejc.2024.101040.2012 · W6927465386
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-09 ⓘ

This meta-analysis found that endometriosis is associated with a 7.34% incidence of ovarian cancer, particularly clear cell and endometrioid types, with better survival rates for early-stage disease.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This systematic review and meta-analysis examined published studies from 2010–2023 to estimate the prevalence and prognosis of endometriosis-associated ovarian cancer (EAOC) within epithelial ovarian cancer, comparing risk factors and outcomes against non-EAOC populations. Across 20 studies including 31,667 women with non-EAOC and 2,826 with EAOC, the analysis estimated an EAOC incidence of 7.34% and found that clear cell and endometrioid ovarian cancer types were relatively more common in EAOC, while low-grade serous was still the most prevalent subtype; CA125 levels were not significantly different between groups. The paper reported that early-stage EAOC had a 1.7-times higher 5-year survival rate compared with non-EAOC, and that EAOC was more common in nulliparous and premenopausal women (odds ratios 2.243 and 2.169), with heterogeneity assessed using Cochran’s Q and I². The paper’s limitation is that it relies on aggregated observational data from included studies and excludes studies without specified sample sizes or cancer prevalence reporting. This paper is centrally about endometriosis-related ovarian cancer—estimating EAOC incidence and comparing survival and risk factors versus non-EAOC groups.

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Abstract

Background: Endometriosis experts recommend monitoring patients until menopause before considering surgery, with concerns about lesion malignancy. This meta-analysis aims to assess the prevalence and prognosis of endometriosis-associated ovarian cancer (EAOC) in various types of epithelial ovarian cancer (EOC), and compare risk factors with the non-EAOC group to improve disease management.Method: In this review, PubMed, Science Direct, Scopus, Google Scholar, and Cochrane databases were searched for "endometriosis" and "ovarian cancer risk factor" from 2010 to 2023. Papers not reporting cancer prevalence or without a specified sample size were excluded. The study used statistical Cochran's Q and I2 index tests to evaluate heterogeneity and estimate ovarian cancer prevalence. Odds ratio was used to explore risk factors for cancer development.Results: In our meta-analysis of 20 studies, 31,667 women with Non-EAOC were compared with 2826 women with EAOC across various factors: EOC subtypes, age, parity, menopausal status, FIGO stage, 5-year survival rate, and Ca125 levels. In our study, EAOC exhibited a 7.34% cancer incidence. While clear cell and endometrioid types were more common in EAOC than in the non-EAOC group, the low-grade serous type was the most prevalent malignancy.Patients with early-stage EAOC have a 1.7 times higher 5-year survival rate compared with non-EAOC groups. EAOC is more common in nulliparous (2.243 times) and premenopausal women (2.169 times), but the CA125 levels are not significantly different between the groups.Conclusion: Based on data and positive outlook, careful monitoring, considering medical history, and avoiding early surgery are highly recommended in endometriotic patients.
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Middle East Journal of Cancer (Jan 2025) Endometriosis-associated Ovarian Cancer, from Risk Factors to Survival Rate: A Systematic Review and Meta-Analysis Abstract Background: Endometriosis experts recommend monitoring patients until menopause before considering surgery, with concerns about lesion malignancy. This meta-analysis aims to assess the prevalence and prognosis of endometriosis-associated ovarian cancer (EAOC) in various types of epithelial ovarian cancer (EOC), and compare risk factors with the non-EAOC group to improve disease management.Method: In this review, PubMed, Science Direct, Scopus, Google Scholar, and Cochrane databases were searched for "endometriosis" and "ovarian cancer risk factor" from 2010 to 2023. Papers not reporting cancer prevalence or without a specified sample size were excluded. The study used statistical Cochran's Q and I2 index tests to evaluate heterogeneity and estimate ovarian cancer prevalence. Odds ratio was used to explore risk factors for cancer development.Results: In our meta-analysis of 20 studies, 31,667 women with Non-EAOC were compared with 2826 women with EAOC across various factors: EOC subtypes, age, parity, menopausal status, FIGO stage, 5-year survival rate, and Ca125 levels. In our study, EAOC exhibited a 7.34% cancer incidence. While clear cell and endometrioid types were more common in EAOC than in the non-EAOC group, the low-grade serous type was the most prevalent malignancy.Patients with early-stage EAOC have a 1.7 times higher 5-year survival rate compared with non-EAOC groups. EAOC is more common in nulliparous (2.243 times) and premenopausal women (2.169 times), but the CA125 levels are not significantly different between the groups.Conclusion: Based on data and positive outlook, careful monitoring, considering medical history, and avoiding early surgery are highly recommended in endometriotic patients. Keywords

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