Two possible entities of endometriosis-associated ovarian cancer: correlated or incidental?

Francesco Mezzapesa, Giulia Dondi, Camelia Alexandra Coadǎ, Camelia Alexandra Coada, Antonio De Leo, Francesca de Terlizzi, Lidia Strigari, Stella Di Costanzo, Gloria Ravegnini, Miriam Santoro, Dario de Biase, Lucia Genovesi, Pierandrea De Iaco, Anna Myriam Perrone
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2025 · vol. 35(4) , pp. 101634 · doi:10.1016/j.ijgc.2025.101634 · PMID:39955191 · W4406240354
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This paper examines the potential connection between endometriosis and ovarian cancer, exploring whether these two conditions are causally linked or merely coincidental occurrences.

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Abstract

OBJECTIVE: This study aimed to describe 2 types of endometriosis-associated ovarian cancer: those with transitional elements (atypical endometriosis and borderline tumors) termed endometriosis-correlated or incidental benign endometriosis vs ovarian cancer cases not associated with endometriosis. METHODS: This was a prospective, observational, monocentric study conducted from November 2021 to December 2023. Patients with ovarian cancer eligible for surgery were enrolled and classified into endometriosis-correlated ovarian carcinoma, endometriosis-incidental ovarian carcinoma, or ovarian carcinoma without endometriosis groups based on the presence or not of endometriosis and transitional lesions. Clinical, sonographic, surgical and pathological data and progression-free survival were recorded. Logistic regression models for accurate patient classification were developed from pre-surgical variables. RESULTS: Of the 170 patients included, 83 (48.82%) had ovarian carcinoma without endometriosis, 39 (22.94%) had endometriosis-incidental ovarian carcinoma, and 48 (28.24%) had endometriosis-correlated ovarian carcinoma. Patients with endometriosis-incidental ovarian carcinoma and endometriosis-correlated ovarian carcinoma were diagnosed at younger ages (p = .002) and had lower post-menopausal rates than patients with ovarian carcinoma without endometriosis (p = .011). Patients with endometriosis-correlated ovarian carcinoma had fewer pregnancies (p < .001) and higher CA-19.9 levels (p = .002) presented with unilateral and multilocular solid lesions than patients with ovarian carcinoma without endometriosis (p < .001). Patients with endometriosis-incidental ovarian carcinoma showed intermediate lesion morphology. Endometriosis-correlated ovarian carcinoma was mostly diagnosed at early Federation of Gynecology and Obstetrics stages (range; I-II) compared with endometriosis-incidental ovarian carcinoma and ovarian carcinoma without endometriosis (p < .001), had less extensive disease (p < .001), and a higher likelihood of complete cytoreduction (p = .035). Endometriosis-correlated ovarian carcinoma was more likely to include clear cell, endometrioid, and mesonephric-like adenocarcinomas, whereas serous histotype predominated in the other groups (p < .001). Logistic regression models accurately identified patients with endometriosis-correlated ovarian carcinoma vs patients with endometriosis-incidental ovarian carcinoma (area under the curve [AUC] = 0.926) and ovarian carcinoma without endometriosis (AUC = 0.968) but could not reliably differentiate endometriosis-incidental ovarian carcinoma from ovarian carcinoma without endometriosis (AUC = 0.668). The 2-year progression-free survival rates were 91% in endometriosis-incidental ovarian carcinoma, 80% in endometriosis-correlated ovarian carcinoma, and 59% in ovarian carcinoma without endometriosis (p = .024). CONCLUSIONS: Our study indicates that ovarian cancer associated with endometriosis consists of 2 clinical entities, with endometriosis-incidental ovarian carcinoma emerging as a bridging group between endometriosis-correlated ovarian carcinoma and ovarian carcinoma without endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial Carcinoma, Ovarian Epithelial

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References (40)

Cited by (5)

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