Endometrioid ovarian cysts: risk factors for recurrence

Objective. To determine the risk factors for the recurrence of endometrioid cysts in infertile patients. Materials and methods. 47 women divided into two distinct groups participated in the study. The first group (n = 39) consisted of women of reproductive age with infertility associated with endometrioid ovarian cysts, who experienced no recurrence of these cysts for a year. Conversely, the second group (n = 8) comprised infertile women of reproductive age, who had a recurrence of endometrioid cysts within the same timeframe. Blood sampling for analysis was performed in all the participants before the surgery, on the 10th day after the operation, and in 6 and 12 months following the surgery. The concentrations of AXIN-1 and haptoglobin were determined in the blood plasma. Results. Risk factors for the recurrence of endometrioid ovarian cysts such as young age 28.5 (27.5–31.5), dysmenorrhea, bilateral lesion, cyst size of 5 (4–6) cm, as well as the dynamics of AXIN-1 and haptoglobin biomarkers were revealed in the study. A statistically significant difference in the level of haptoglobin which reflects the presence of oxidative stress provoked by ferroptosis in the cysts and beyond them was determined in patients with recurrent endometriomas. The phenomenon of ferroptosis was shown to contribute to fibrosis of not only the tissues of the ovary itself, but also to the formation of adhesions in the appendages, which was most pronounced in the relapse group. High concentrations of AXIN-1 and its slow dynamics of decline in patients with recurrent endometrioid cysts reflect the aggressiveness of cellular proliferation, bypassing apoptosis and leading to repeated relapse. The combination of the above-mentioned biomarkers is also promising for early detection of recurrence of endometrioid ovarian cysts – 6 months after the surgery. Conclusion. The following clinical, anamnestic, intraoperative and laboratory data were identified as significant risk factors for the recurrence: patients` younger age of 28.5 (27.5–31.5), dysmenorrhea, bilateral nature of the lesion and cyst size of 5 (4–6) cm, as well as the dynamics of biomarkers after surgery. Analysis of the dynamics of AXIN-1 and haptoglobin biomarkers can be considered not only as a criterion for the recurrence of endometrioid cysts, but also as an important aspect of planning surgical intervention, since the connection with the adhesive process was revealed.