J Gynecol Oncol.
2018 May;29(3):e28. 10.3802/jgo.2018.29.e28.
Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data
- Affiliations
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- 1Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- 2Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
- 3Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan. cchang@math.nsysu.edu.tw
- 4Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- 5Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.
- 6School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- 7Department of Obstetrics and Gynecology, Yuan's General Hospital, Kaohsiung, Taiwan.
- 8Multidisciplinary Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan. jiabinchung@gmail.com
- 9Da-Yeh University, Changhua, Taiwan.
- KMID: 2409932
- DOI: http://doi.org/10.3802/jgo.2018.29.e28
Abstract
OBJECTIVE
The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data.
METHODS
The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated.
RESULTS
A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p < 0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p < 0.05). The validated C-index was 0.69.
CONCLUSION
For a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.
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