子宮內膜異位與某些卵巢癌亞型有關


  【24drs.com】一篇新研究發現,某些組織學亞型子宮內膜異位與侵犯性上皮卵巢癌風險增加有關;特別的是,子宮內膜異位病史只和侵犯性低等級、漿液性、透明細胞、子宮內膜樣卵巢癌風險增加有關。
  
  這篇刊載於Lancet Oncology期刊中的一篇彙整分析顯示,子宮內膜異位和發生透明細胞型卵巢癌的機會增加3倍以上有關,而發生子宮內膜樣腫瘤風險超過2倍。
  
  至於子宮內膜異位和高等級漿液性或侵犯性卵巢癌、其他類型的邊緣性腫瘤之間則未發現有所關聯。
  
  Charlie Gourley博士在編輯評論寫道,檢視特定組織型亞型之間的關聯,為這些組織學亞型和特定疾病的關聯增添有力證據。
  
  英國愛丁堡大學癌症研究中心腫瘤內科名譽顧問Gourley醫師寫道,這些疾病的細胞起源和分子基礎還有許多需要暸解,而辨識這些亞型受到子宮內膜異位等疾病的影響,則可幫助暸解病程、發展可成功預防或治療的策略。
  
  還不清楚如何將這些結果運用到篩檢計畫。
  
  彙整分析的南加大Keck醫學院預防醫學系助理教授Celeste Leigh Pearce醫師在聲明中表示,這次的突破可更佳辨識卵巢癌風險增加的婦女,提供相關族群癌症監測率提升之基礎,獲得個人化的預防與早期偵測方式,例如降低手術風險和篩檢。
  
  不過,Gourley醫師在評論中指出,這篇研究中,上皮卵巢癌風險增加或許並不足以證明針對子宮內膜異位病患進行卵巢癌篩檢,但事實上,某些相關的組織學亞型主要表現在早期階段,可作為篩檢考量。
  
  此外,風險增加的程度和主要的相關病灶對跨科別團隊相當重要,有助於評估子宮內膜異位患者不確定原因的病灶,這些資料重申了注意侵犯性疾病的可能性、以及可能存在的必要性。
  
  Pearce醫師等人的分析是國際性的團隊努力所得,彙整了13個卵巢癌案例資料–「卵巢癌協會聯盟」的部份控制研究,分析案例的組織學亞型、等級、階段、病患年紀、種族、研究地點、一致性、使用口服避孕藥的期間等等。
  
  研究對象包括了13,226名對照組與 7,911名侵犯性乳癌婦女,對照組有818人(6.2%)、卵巢癌患者有738人(9.3%)表示有子宮內膜異位史,1,907名婦女有邊緣性卵巢癌,其中168人(8.8%)表示有子宮內膜異位史。
  
  整體而言,各亞型有子宮內膜異位史的情況分別是,透明細胞型腫瘤的674名婦女有136人(20.2%)、子宮內模樣腫瘤的1,220人有169人(13.9%)、黏蛋白性腫瘤的516人有31人(6.0%)、高等級漿液性腫瘤的3,659人有261人(7.1%)、低等級漿液性侵犯性卵巢癌的336人有31人(9.2%)。
  
  此外,邊緣性漿液型腫瘤的1,140人有103人(9.0%)、邊緣性黏蛋白性腫瘤的767人有65人(8.5%)表示有子宮內膜異位史。
  
  其他干擾因素包括哺乳、體重、身高、身體質量指數、輸卵管結紮手術、卵巢癌家族史,都不會影響癌症風險和子宮內膜異位的關聯。
  
  分析顯示,相較於侵犯性高等級或侵犯性黏蛋白型卵巢癌,子宮內膜異位比較常見於侵犯性透明細胞型、低等級漿液型、子宮內膜樣卵巢癌(各項比較皆P< .02),子宮內膜異位和侵犯性透明細胞型卵巢癌的關聯性大於侵犯性子宮內膜樣亞型(風險比[OR],1.64;P= .001),侵犯性低等級的關聯也比高等級漿液型卵巢癌更強烈(OR,1.94;P= .01)。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6738&x_classno=0&x_chkdelpoint=Y

Endometriosis Linked to Certain Subtypes of Ovarian Cancer

By Roxanne Nelson
Medscape Medical News

February 21, 2012 — A new study has defined the histologic subtypes of endometriosis that are associated with an increased risk for invasive epithelial ovarian cancer. Specifically, a history of endometriosis is only associated with an increased risk for invasive low-grade serous, clear-cell, and endometrioid ovarian cancer.

A pooled analysis published online today in the Lancet Oncology has shown that endometriosis is linked to a more than 3-fold chance of developing clear-cell ovarian cancers, and more than double the risk of developing endometrioid tumors.

No association was observed between endometriosis and the risk for high-grade serous or invasive ovarian cancer, or borderline tumors of either type.

Identifying an association between particular histologic subtypes and not others adds weight to the increasing evidence that these histologic subtypes are distinct disease entities, writes Charlie Gourley, MB ChB, PhD, in an accompanying comment.

"There is still much to learn about the cellular origins and molecular basis of these distinctions, but identification of the subtypes affected by processes like endometriosis should help in the task of detailing the process and developing strategies to allow successful prevention or treatment," writes Dr. Gourley, who is a reader and honorary consultant in medical oncology at the University of Edinburgh Cancer Research Centre, United Kingdom.

How these results are applicable to screening programs is still unclear.

Lead investigator of the pooled analysis, Celeste Leigh Pearce, MD, assistant professor in the Department of Preventive Medicine at the Keck School of Medicine, University of Southern California, Los Angeles, said in a statement: "This breakthrough could lead to better identification of women at increased risk of ovarian cancer and could provide a basis for increased cancer surveillance of the relevant population, allowing better individualization of prevention and early detection approaches such as risk-reduction surgery and screening."

However, in his comment, Dr. Gourley notes that the increased risk for epithelial ovarian cancer seen in the study is "perhaps not in itself sufficient to justify targeted ovarian cancer screening of patients with a history of endometriosis," But, he adds, the fact that some of the associated histologic subtypes predominantly present at an early stage make screening a consideration.

"Additionally, the extent of this increased risk and the predominantly associated lesions have implications for the multidisciplinary team when they come to assess lesions of uncertain cause in a patient with a history of endometriosis," he writes. "These data reaffirm the necessity to be vigilant for the possibility that invasive disease might be present."

Linked to 2 Subtypes Only

The analysis by Dr. Pearce and colleagues was an international collaborative effort; it pooled data from 13 ovarian cancer case–control studies that were part of the Ovarian Cancer Association Consortium. Cases were analyzed for histologic subtype, grade, and stage, and patient age, ethnic origin, study site, parity, and duration of oral contraceptive use were included in all analytical models.

The cohort consisted of 13,226 control subjects and 7911 women with invasive ovarian cancer. Of this group, 818 (6.2%) of the control women and 738 (9.3%) of ovarian cancer patients reported having a history of endometriosis. In addition, 1907 women had borderline ovarian cancer, with 168 (8.8%) of them reporting a history of endometriosis.

Overall, a history of endometriosis was reported by 136 of 674 (20.2%) women with clear-cell, 169 of 1220 (13.9%) women with endometrioid, 31 of 516 (6.0%) women with mucinous, 261 of 3659 (7.1%) women with high-grade serous, and 31 of 336 (9.2%) women with low-grade serous subtypes of invasive ovarian cancer.

In addition, 103 of 1140 (9.0%) women with borderline serous and 65 of 767 (8.5%) women with borderline mucinous tumors reported having a history of endometriosis.

Confounders, including breast feeding, weight, height, body mass index, tubal ligation, and a family history of ovarian cancer, did not influence the association between cancer risk and endometriosis.

The analysis showed that a history of endometriosis was more commonly reported by patients with invasive clear-cell, serous low-grade, and endometrioid ovarian cancers than in those with invasive serous high-grade or invasive mucinous ovarian cancers (P < .02 for all comparisons). Endometriosis was also more strongly linked to invasive clear-cell ovarian cancer than to the invasive endometrioid subtype (odds ratio [OR], 1.64; P = .001), and was more strongly associated with invasive low-grade than with high-grade serous ovarian cancer (OR, 1.94; P = .01).

The study was funded by multiple international sources, as noted in the paper. The authors and the editorialist have disclosed no relevant financial relationships.

Lancet Oncol. Published online February 21, 2012.

    
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