子宫内膜异位症女性卵巢癌风险、患病率与生存结局：Endocancer系统综述与荟萃分析
结果显示内异症增加卵巢癌相对风险（OR 1.82、HR 3.03、SIR 1.62），但EAOC患者更年轻、多为早期低级别肿瘤，总生存优于非EAOC（HR 0.48）。
要点
- 内异症女性卵巢癌相对风险升高，但绝对风险仍低，需个体化咨询。
- EAOC以透明细胞和子宫内膜样亚型为主，诊断时多为早期、低级别。
- EAOC总生存优于非EAOC，复发与死亡更低，铂耐药相似。
核心结论
- 子宫内膜异位症增加卵巢癌的相对风险，但绝对风险仍低；EAOC具有独特的临床病理特征和更好的生存结局，支持表型为基础的风险分层与恶性转化分子标志物研究。
主要发现
- 内异症增加卵巢癌风险：OR 1.82、HR 3.03、SIR 1.62。
- EAOC患者更年轻、更多为绝经前，更常为早期肿瘤（OR 0.29）和低级别肿瘤（OR 1.71）。
- 透明细胞和子宫内膜样组织学亚型占主导。
- EAOC总生存显著更好（HR 0.48），复发和死亡更低，铂耐药相似。
关键数值与推荐
- 风险合并值：OR 1.82、HR 3.03、SIR 1.62。
- 早期诊断OR 0.29，低级别肿瘤OR 1.71。
- 总生存HR 0.48。
临床怎么用
- 对子宫内膜异位症女性可进行个体化咨询，说明相对风险升高但绝对风险低。
- 关注EAOC以透明细胞和子宫内膜样亚型为主、多为早期低级别的特点。
- EAOC生存预后较好，但仍需重视复发监测与铂耐药评估。
局限性
- 原文摘要未报告各纳入研究的异质性、偏倚风险及具体随访时长等细节，相关局限无法从本文获知。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: Endometriosis is linked to an increased risk of epithelial ovarian cancer (EOC), especially clear cell and endometrioid subtypes. The extent and prognostic significance of this link are still not fully understood. This systematic review and meta-analysis compiles existing evidence on ovarian cancer risk, histotype distribution, and survival outcomes in women with endometriosis. DATA SOURCES: Systematic search up to August 2025. METHODS OF STUDY SELECTION: A systematic search of PubMed and Google Scholar was performed up to August 2025. Studies reporting ovarian cancer risk estimates or survival outcomes in endometriosis-associated ovarian cancer (EAOC) were included. Random-effects models generated pooled odds ratios (OR), hazard ratios (HR), and standardized incidence ratios (SIR). Risk analyses included >500 000 women; survival analyses >10 000. TABULATION, INTEGRATION, AND RESULTS: Sixty-seven studies met inclusion criteria. Endometriosis increased ovarian cancer risk (OR: 1.82, HR: 3.03, SIR: 1.62). EAOC patients were younger, more often premenopausal, and more frequently diagnosed with early-stage (OR: 0.29) and low-grade tumors (OR: 1.71). Clear cell and endometrioid histotypes predominated. Overall survival was significantly better in EAOC (HR: 0.48); recurrence and mortality were lower, while platinum resistance was similar. CONCLUSION: Endometriosis confers an increased relative but still low absolute risk of ovarian cancer. EAOC exhibits distinct clinicopathologic features and improved survival compared with non-EAOC. These findings support personalized counseling and emphasize the need for phenotype-based risk stratification and molecular markers of malignancy transformation.
引用
- Piacenti I, Tius V, Gomba B, et al. Risk, Prevalence and Survival Outcomes of Ovarian Cancer in Women With Endometriosis: The Endocancer Systematic Review and Meta-Analysis. J Minim Invasive Gynecol. 2026. PMID: 42102910. doi:10.1016/j.jmig.2026.04.021
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。