Risk factors for recurrence of endometrioid ovarian cysts after combined treatment

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BACKGROUND: The main method of endometrioid ovarian cyst treatment is considered surgery with further hormone therapy. However, the recurrence rate of endometriomas, even 5–7 years after combined treatment, can reach 50%.

AIM: The aim of this study was to identify risk factors for recurrence of endometrioid ovarian cysts among women of reproductive age after combined treatment.

MATERIALS AND METHODS: This study included 196 women operated on for ovarian endometriosis. We carried out a comparative analysis of the data between the study groups: the main group comprised 45 patients with a relapse of the disease; the comparison group consisted of 151 women without a relapse. Hematoxylin-eosin staining was used for morphological examination of the surgical material, and monoclonal mouse antibodies to Ki-67 and bcl-2 (DAKO, Denmark) were used for immunohistochemical examination. The construction of a statistical model for predicting the recurrence of ovarian endometriosis among women of reproductive age was carried out using multivariate binary logistic regression analysis in reverse stepwise mode. The influence of the independent variable on the likelihood of recurrence was determined using the odds ratio and its 95% confidence interval, with the sensitivity, specificity and diagnostic accuracy evaluated.

RESULTS: A set of predictors has been identified that provides the greatest contribution to recurrence of ovarian endometriosis. Immunohistochemistry study showed that the level of Ki-67 protein was higher in the group with relapsed endometriomas compared to the non-recurrent course: in the epithelial lining of the cyst, 9.08 ± 2.60 and 2.06 ± 1.16%, respectively (p = 0.043); in the cytogenic stroma, 11.67 ± 4.10 and 9.81 ± 3.40%, respectively (p = 0.48). Bcl-2 expression was reduced in the epithelial lining of the cyst capsule in the main group in comparison with the material where there was no recurrence: 0.653 ± 0.043 and 0.961 ± 0.056%, respectively (p = 0.31).

CONCLUSIONS: Of significance in predicting the risk of recurrence of ovarian endometriosis is a combination of four signs in one patient: primary infertility; pelvic organ surgery in history, unrelated to endometriosis; elevated levels of CA-125 oncoprotein and proliferative changes in cytogenic stroma cells, as well as increased expression of the Ki-67 antigen in the epithelial lining of the endometrioid cyst.

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About the authors

Nikol N. Petrovskaia

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: dr.ramzaeva@mail.ru
ORCID iD: 0000-0001-6849-5335
SPIN-code: 7769-1969
Scopus Author ID: 57838172500
Russian Federation, Saint Petersburg

Victoria A. Pechenikova

North-Western State Medical University named after I.I. Mechnikov

Email: p-vikka@mail.ru
ORCID iD: 0000-0001-5322-708X
SPIN-code: 9603-5645

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg


  1. Seo JW, Lee DY, Yoon BK, et al. The age-related recurrence of endometrioma after conservative surgery. Eur J Obstet Gynecol Reprod Biol. 2017;208:81–85. doi: 10.1016/j.ejogrb.2016.11.015
  2. Fassbender A, Overbergh L, Verdrengh E, et al. How can macroscopically normal peritoneum contribute to the pathogenesis of endometriosis? Fertil Steril. 2011;96(3):697–699. doi: 10.1016/j.fertnstert.2011.06.034
  3. Shen F, Wang Y, Lu Y, et al. Immunoreactivity of progesterone receptor isoform B and nuclear factor kappa-B as biomarkers for recurrence of ovarian endometriomas. Am J Obstet Gynecol. 2008;199(5):486.e1-486.e10. doi: 10.1016/j.ajog.2008.04.040
  4. Tikhonchuk EYu, Asaturova AV, Adamyan LV, et al. Endometrial molecular biological changes in women with external genital endometriosis. Akusherstvo i ginekologiya. 2016;(11):42–48. (In Russ.). doi: 10.18565/aig.2016.11
  5. Tikhonchuk EYu, Nepsha OS, Adamyan LV, et al. ‘Omic’ high-throughput technologies in research on pathogenesis of endometriosis: a review. Problemy reproduktsii. 2016;22(5):110–122. (In Russ.). doi: 10.17116/repro2016225110-122
  6. Kuznetsova MV, Pshenichnyuk EYu, Burmenskaya OV, et al. Study of gene expressions in the eutopic endometrium of women with endometrioid ovarian cysts. Akusherstvo i ginekologiya. 2017;8:93–102. (In Russ.). doi: 10.18565/aig.2017.8.93-102
  7. Ouchi N, Akira S, Mine K, et al. Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention. J Obstet Gynaecol Res. 2014;40(1):230–236. doi: 10.1111/jog.12164
  8. Koga K, Takamura M, Fujii T, et al. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril. 2015;104(4):793–801. doi: 10.1016/j.fertnstert.2015.08.026
  9. Somigliana E, Vercellini P, Vigano P, et al. Postoperative medical therapy after surgical treatment of endometriosis: from adjuvant therapy to tertiary prevention. J Minim Invasive Gynecol. 2014;21(3):328–334. doi: 10.1016/j.jmig.2013.10.007
  10. Vercellini P, Somigliana E, Viganò P, et al. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online. 2010;21(2):259–265. doi: 10.1016/j.rbmo.2010.04.018
  11. Candiani M, Ottolina J, Posadzka E, et al. Assessment of ovarian reserve after cystectomy versus ‘one-step’ laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial. Hum Reprod. 2018;33(12):2205–2211. doi: 10.1093/humrep/dey305
  12. Han S, Lee H, Kim S, et al. Risk factors related to the recurrence of endometrioma in patients with long-term postoperative medical therapy. Ginekol Pol. 2018;89(11):611–617. doi: 10.5603/GP.a2018.0105
  13. Kikuchi I, Takeuchi H, Kitade M, et al. Recurrence rate of endometriomas following a laparoscopic cystectomy. Acta Obstet Gynecol Scand. 2006;85(9):1120–1124. doi: 10.1080/00016340600627154
  14. Koga K, Takemura Y, Osuga Y, et al. Recurrence of ovarian endometrioma after laparoscopic excision. Hum Reprod. 2006;21(8):2171–2174. doi: 10.1093/humrep/del125
  15. Sengoku K, Miyamoto T, Horikawa M, et al. Clinicopathologic risk factors for recurrence of ovarian endometrioma following laparoscopic cystectomy. Acta Obstet Gynecol Scand. 2013;92(3):278–284. doi: 10.1111/aogs.12051
  16. Guo H, Shen A, Xu S, et al. Analysis of relevant factors for recurrence of ovarian endometriosis after conservative laparoscopic surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016;41(4):405–410. doi: 10.11817/j.issn.1672-7347.2016.04.011
  17. Li XY, Chao XP, Leng JH, et al. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. J Ovarian Res. 2019;12(1):79. doi: 10.1186/s13048-019-0552-y
  18. Hidari T, Hirata T, Arakawa T, et al. Contralateral ovarian endometrioma recurrence after unilateral salpingo-oophorectomy. BMC Womens Health. 2019;19(1):59. doi: 10.1186/s12905-019-0760-z
  19. Huang G, Fan X, Zhu P. Analysis of recurrence factors associated with conservative surgery for ovarian-type endometriosis. Ann Transl Med. 2022;10(5):255. doi: 10.21037/atm-22-189
  20. Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis. Obstet Gynecol. 2002;99(3):375–380. doi: 10.1016/s0029-7844(01)01731-8
  21. Toki T, Kubota J, Lu X, et al. Immunohistochemical analysis of CA125, CA19-9, and Ki-67 in stage III or IV endometriosis: positive correlation between serum CA125 level and endometriotic epithelial cell proliferation. Acta Obstet Gynecol Scand. 2000;79(9):771–776.
  22. Kahyaoglu I, Kahyaoglu S, Moraloglu O, et al. Comparison of Ki-67 proliferative index between eutopic and ectopic endometrium: a case control study. Taiwan J Obstet Gynecol. 2012;51(3):393–396. doi: 10.1016/j.tjog.2012.07.013
  23. Pshenichnyuk EYu, Asaturova AV, Adamyan LV, et al. Immunohistochemical predictors of recurrent ovarian endometriomas after laparoscopic surgery. Arkhiv Patologii. 2018;80(4):14–20. (In Russ.). doi: 10.17116/patol201880414
  24. Carvalho L, Podgaec S, Bellodi-Privato M, et al. Role of eutopic endometrium in pelvic endometriosis. J Minim Invasive Gynecol. 2011;18(4):419–427. doi: 10.1016/j.jmig.2011.03.009

Supplementary files

Supplementary Files
1. Fig. 1. Assessment of the relationship of significant risk factors with the likelihood of recurrent ovarian endometriosis after combined treatment according to multivariate logistic regression analysis. OR — odds ratio; CI — confidence interval

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2. Fig. 2. Recurrent endometrioid ovarian cyst: a, expression of bcl-2 oncoprotein; b, expression of Ki-67 in the endometrial cytogenic stroma; c, expression of Ki-67 in the epithelial lining of the endometrioid cyst. Immunohistochemistry study, zoom ×200

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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