Human Reproduction Update Advance Access originally published online on March 11, 2009
Human Reproduction Update 2009 15(4):441-461; doi:10.1093/humupd/dmp007
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Recurrence of endometriosis and its control
Institute of Obstetric and Gynecologic Research, Shanghai Jiao Tong University School of Medicine, Renji Hospital, 145 Shandong Zhong Road, Shanghai 200001, People's Republic of China
1 Correspondence address. Fax: +86-21-5388-2377; E-mail: hoxa10{at}gmail.com
BACKGROUND: Although surgery is currently the treatment of choice for managing endometriosis, recurrence poses a formidable challenge. To delay or to eliminate the recurrence is presently an unmet medical need in the management of endometriosis. To this end, proposals to investigate patterns of recurrence, to develop biomarkers for recurrence and to carry out biomarker-based intervention have been made.
METHODS: Publications pertaining to the recurrence of endometriosis and its related yet unaddressed issues were identified through MEDLINE. The reported recurrence rates, risk factors for recurrence, the effects of post-operative medication and causes of recurrence were reviewed and synthesized. In addition, several poorly explored issues such as time hazard function and mechanisms of recurrence were reviewed. Approaches to the development of biomarkers for recurrence and future intervention are discussed.
RESULTS: The reported recurrence rate was high, estimated as 21.5% at 2 years and 40–50% at 5 years. Few risk factors for recurrence have been consistently identified, and the evidence on the efficacy of the post-operative use of medication was scanty. The investigation on the patterns of recurrence may provide us with new insight into the possible mechanisms of recurrence and its control. The attempt to identify biomarkers for recurrence has started only very recently.
CONCLUSIONS: Much research is needed to better understand the patterns of recurrence and risk factors, and to develop biomarkers. One top priority is to develop biomarkers for recurrence, which may provide much needed clues to the possible mechanisms underlying recurrence and would allow the identification of patients with high recurrence risk, and permit for targeted intervention.
Key words: biomarker / control / endometriosis / hazard / recurrence
Received on March 24, 2008; revised January 22, 2009; accepted on February 3, 2009
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