The ectopic endothelial abnormality endosalpingiosis doubled the likelihood of concurrent gynecologic malignancy as compared with endometriosis and conferred worse overall survival (OS), a retrospective case-control study showed.
Among 515 patients with endosalpingiosis, 40.1% had concurrent cancer as compared with 18% of patients who had endometriosis. The significant association between endosalpingiosis and malignancy persisted after exclusion of patients with known or suspected malignancy.
By multivariable analysis patients with endosalpingiosis had a survival hazard of 1.69 versus patients with a diagnosis of endometriosis, reported Aakriti R. Carrubba, MD, of the Mayo Clinic in Jacksonville, Florida, and co-authors, in Gynecologic Oncology.
“As the awareness of ES [endosalpingiosis] heightens, future research on this diagnosis is needed,” the authors wrote. “Long-term follow-up is essential for assessment of distant outcomes such as development of cancer in patients with known endosalpingiosis. Without long-term data, we cannot change our approach to patient counseling, screening, and risk reduction procedures.”
Endosalpingiosis arises as tube-like glandular epithelium that resembles, but occurs outside, the fallopian tubes. The condition has a nonspecific presentation and is usually identified as an incidental surgical or pathologic finding, the researchers noted. Among patients undergoing gynecologic laparoscopic surgery, endosalpingiosis has an estimated prevalence of 7.6%.
The pathogenesis of endosalpingiosis remains unclear, the authors continued. Several studies have suggested an association of endosalpingiosis with gynecologic malignancy; whether endosalpingiosis is a premalignant condition is unknown.
Carrubba and colleagues performed the retrospective case-control study to investigate the association between endosalpingiosis and concurrent malignancy. They hypothesized that co-occurrence of malignancy would be higher with endosalpingiosis than with endometriosis.
Data for the study came from medical records at three U.S. academic hospitals, covering diagnoses from 2000 to 2020. The analysis comprised 515 cases of endosalpingiosis and 452 matched cases of endometriosis. Patients with endosalpingiosis were significantly older (age 52 vs 48, P<0.0001), and the group had a higher proportion of patients with known genetic mutations (3.9% vs 2.2%, P=0.008). Significantly more patients with endometriosis reported chronic pain (47.0% vs 28.4%, P<0.001). Otherwise, the groups were well matched for baseline characteristics.
Consistent with the working hypothesis, significantly more patients with endosalpingiosis had concurrent gynecologic malignancies (P<0.001). In both groups, ovarian and uterine cancers were the most common malignancies, accounting for more than 90% of concurrent malignancies. The two groups did not differ significantly with respect to any of the identified cancers. The data showed that 32 cancers were diagnosed during postoperative follow-up, and 72% of those were non-gynecologic malignancies.
When patients with known or suspected malignancies were excluded, the association between endosalpingiosis and concurrent cancer remained significantly greater as compared with the association of endometriosis with cancer (20.9% vs 5.6%, P<0.001).
Endosalpingiosis was associated with significantly worse survival. With a median follow-up of 72.7 months, the estimated 10-year freedom from death was 77% in patients with endosalpingiosis versus 90.5% for those with endometriosis (P<0.001).
By multivariable analysis patients with endosalpingiosis had more than a twofold greater likelihood of concurrent cancer as compared with patients who had endometriosis (OR 2.48, P<0.001). Additionally, the survival hazard was significantly increased with endosalpingiosis versus endometriosis (OR 1.69, P=0.017).
Endosalpingiosis is a pathologic finding, probably a normal condition, and has no signs or symptoms, said Robert DeBernardo, MD, of the Cleveland Clinic, who was not involved with the study.
“It does not have any real clinical significance, so this association is interesting,” he told MedPage Today via email. “However, I doubt the validity of the authors’ conclusions as this was a retrospective review of cases and compared the association with cancer to that of endometriosis. In short, given this is a diagnosis that is made under the microscope from a surgical specimen, perhaps it would be important to a pathologist to say ‘does this patient have an endometrial cancer because I am seeing endosalpingiosis — perhaps I should look more closely.'”
Carrubba and co-authors reported having no conflicts of interest.
DeBernardo reported no relevant relationships.