title: The Risk of Epithelial Ovarian Cancer of Women With Endometriosis May be Varied Greatly if Diagnostic Criteria Are Different: A Nationwide Population-Based Cohort Study.
abstract: This article aims to test the hypothesis that the risk of epithelial ovarian cancer (EOC) in women with endometriosis might be changed by enrolling different population. A nationwide 14-year historic cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan and the Registry for Catastrophic Illness Patients was conducted. A total of 239,385 women aged between 20 and 51 years, with at least 1 gynecologic visit after 2000, were analyzed. Cases included women with a diagnosed endometriosis, which was established along a spectrum from at least 1 medical record of endometriosis (recalled endometriosis) to tissue-proved ovarian endometriosis (n = X). Controls included women without any diagnosis of endometriosis (n = 239,385 - X). We used Cox regression, and computed hazard ratios (HRs) with 95% confidence intervals (95% CI) to determine the risk of EOC in patients. The EOC incidence rates (IRs, per 10,000 person-years) of women with endometriosis ranged from 1.90 in women with recalled endometriosis to 18.70 in women with tissue-proved ovarian endometrioma, compared with those women without any diagnosis of endometriosis (0.77-0.89), contributing to crude HRs ranging from 2.59 (95% CI, 2.09-3.21; P < 0.001) to 24.04 (95% CI, 17.48-33.05; P < 0.001). After adjustment for pelvic inflammatory disease, infertility, Charlson co-morbidity index, and age, adjusted HRs were ranged from the lowest of 1.90 (95% CI, 1.51-2.37; P < 0.001) in recalled endometriosis to the highest of 18.57 (95% CI, 13.37-25.79; P < 0.001) in tissue-proved ovarian endometrioma, which was inversely related to the prevalence rate of endometriosis (from the highest of 30.80% in recalled endometriosis to the lowest of 1.54% in tissue-proved ovarian endometrioma). The risk of EOC in women with endometriosis varied greatly by different criteria used. Women with endometriosis might have a more apparently higher risk than those reported by systematic review and meta-analysis.
authors.affiliation: From the Department of Nursing, Oriental Institute of Technology, New Taipei City (W-LL, K-CW); Department of Medicine, Cheng-Hsin General Hospital (W-LL); Department of Obstetrics and Gynecology (W-LL, M-SY, P-HW); Department of Nursing (W-LL, W-HC, P-HW); Institute of Hospital and Health Care Administration and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (C-YG, Y-JC, NH); Department of Nursing (W-HC); Department of Obstetrics and Gynecology (W-HC, M-SY, P-HW); Biostatics Task Force, Taipei Veterans General Hospital, Taipei, Taiwan (H-YH); Department of Medical Research (P-HW); and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Lee
authors.forename: Wen-Hsun
authors.initials: WH
authors.lastname: Chang
authors.forename: Kuan-Chin
authors.initials: KC
authors.lastname: Wang
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Guo
authors.forename: Yiing-Jeng
authors.initials: YJ
authors.lastname: Chou
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Huang
authors.forename: Ming-Shyen
authors.initials: MS
authors.lastname: Yen
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000077216:Carcinoma, Ovarian Epithelial; D016022:Case-Control Studies; D002388:Catastrophic Illness; D015331:Cohort Studies; D016208:Databases, Factual; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009313:National Health Programs; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult