Clinical and laboratory peculiarities in postmenopausal patients with benign ovarian tumors

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Introduction

In the Russian Federation, as in the rest of the world, there has been a tendency, over the past few years, towards an increase in the structure of the population of people of advanced reproductive and elderly age. According to the Russian Statistics Agency (Rosstat) data for 2021, the number of citizens aged 65+ was 22 million people (15 % of the country's population). The number of a wider group of the population – older working age – is 37.99 million people (25.9 % of the population) [1]. The number of postmenopausal women is also increasing proportionally. Given the high social activity of these women, maintaining a high quality of life for them is an extremely important aspect of modern healthcare.

One of the most common diseases in gynecology is ovarian tumors: the incidence of this nosology reaches 25 % among all neoplasms of the female reproductive system [2]. In 75-80 % of cases, neoplasms are benign. The absence of characteristic clinical symptoms of the disease, often a long asymptomatic course with late manifestation, as well as the lack of a single diagnostic algorithm, greatly complicates the work of clinicians today.

Thus, issues of early diagnosis of ovarian neoplasms, as well as the development of methods for disease prevention are a priority in modern medical science.

Materials and methods

In 2022, a prospective study was conducted at the Gynecology Department of the Perm Regional Clinical Hospital using specially developed cards; 40 postmenopausal female patients admitted to the gynecological department for surgical treatment of benign ovarian neoplasms were selected – they comprised the main group; and a comparison group was identified: 15 patients admitted for treatment of other gynecological pathologies and without ovarian tumors. All patients were assigned to a certain age group according to the STRAW +10 Scale, an obstetric and gynecological anamnesis was collected, concomitant somatic pathology was identified, clinical and laboratory research data were obtained – ultrasound of the pelvic organs, clinical and biochemical blood tests, CA-125, a study of the level of FSH (follicle-stimulating hormone), leptin, SHBG (sex hormone-binding globulin), vitamin D was performed, and an analysis of histological research data was performed.

Quantitative characteristics are presented as a confidence interval (95 %) Me (Q₁–Q₃), qualitative characteristics are presented as a confidence interval (95 %) (n) % ± 2m. The reliability of differences between groups was assessed using the Pearson chi-square test; differences were considered reliable at a significance level of p < 0.05.

Results and discussion

Patients in the main group and comparison group were represented by the following age categories: STRAW+2, STRAW +1c, STRAW +1b (Table 1).

 

Table 1

Patients by age categories in the main group and comparison group, %

Parameter	Main group, n = 40	Comparison group, n = 15	p
STRAW+2	(31) 77.5 ± 13.2	(8) 53.3 ± 25.8	0.079
STRAW +1с	(8) 20.0 ± 12.6	(5) 33.3 ± 24.3	0.300
STRAW +1b	(1) 2.5 ± 4.9	(2) 13.3 ± 18.8	0.037

 

When comparing the studied characteristics in both groups, a number of differences were found. The following somatic diseases were predominant in the patients of the main group: arterial hypertension, chronic gastritis, biliary tract diseases. The patients of the comparison group had the following concomitant somatic diseases: arterial hypertension, thyroid pathology, ischemic heart disease (Table 2).

 

Table 2

 Somatic pathology in patients of the main group and comparison group

Characteristics	Main group, n = 40	Comparison group, n = 15	p
Arterial hypertension	(22) 55.0 ± 15.7	(8) 53.3 ± 27.6	0.122
Chronic gastritis	(17) 42.5 ± 15.6	0	0.002
Bile passages diseases	(10) 25.0 ± 13.7	0	0.032
Chronic pyelonephritis	(5) 12.5 ± 10.5	0	0.151
Thyroid pathology	(5) 12.5 ± 10.5	(3) 20.0 ± 20.0	0.482
Type 2 diabetes mellitus	(5) 12.5 ± 10.5	0	0.151
CHD	(1) 2.5 ± 2.5	(2) 13.3 ± 13.3	0.115

 

In addition to benign ovarian tumors, patients in the main group had gynecological diseases: chronic salpingitis ((n = 18) 45.0 ± 15.7 %), uterine leiomyoma ((n = 8) 20.0 ± 12.6 %), chronic cervicitis ((n = 6) 15.0 ± 11.3 %), adenomyosis ((n = 3) 7.5 ± 7.5 %).

In patients of the main group, the following types of ovarian tumors were histologically verified: serous cystadenoma ((n = 30) 75.0 ± 13.7 %), serous coarse papillary cystadenoma ((n = 3) 7.5 ± 7.5 %), endometrioma ((n = 3) 7.5 ± 7.5 %), mature teratoma ((n = 3) 7.5 ± 7.5 %), mucinous cystadenoma ((n = 2) 5.0 ± 5.0 %), cystadenofibroma ((n = 2) 5.0 ± 5.0 %), Brenner tumor ((n = 2) 5.0 ± 5.0 %) (Figure).

 

Fig. Histological types of tumors in patients of the main group

 

In the laboratory parameters of the patients in the main group, a decrease in the level of vitamin D was noticeable (mean value 22.1 (16.9–28.4) ng/ml). Elevated leptin levels were found (mean 16.3 (11.4–39.5) ng/ml). An increase in ESR (above 20 mm/h) was also detected, as well as an increase in cholesterol in (n = 22) 55.0 ± 15.7 %), erythrocytosis was detected in 17 women – 42.5 ± 15.6 %, an increase in ESR in 12 – 30.0 ± 14.5 %, CA-125 exceeded reference values ​​in only one patient (2.5 ± 2.5 %). An increase in FSH was found above the reference values ​​for the age norm (26.7–133.4 mIU/ml), with the mean value being 57.5 (47.09–78.53) mIU/ml, an increase in SHBG – the mean value was 61.1 (53.8–91.2) nmol/l (Table 3).

 

Table 3

Laboratory parameters of the main group and comparison group

Characteristics	Main group, n = 40	Comparison group, n = 15	p
ESR increase	(12) 30.0 ± 14.5	(6) 40.0 ± 25.3	0.481
Decrease in vitamin D	(31) 77.5 ± 13.2	(10) 66.7 ± 24.3	0.411
Increase in FSH	(7) 17.5 ± 12.0	(9) 60.0 ± 25.3	0.002
Increase in leptin	(30) 75.0 ± 13.7	(8) 53.3 ± 25.8	0.121
SHBG increase	(2) 5.0 ± 5.0	(3) 20.0 ± 20.0	0.085

 

In the laboratory tests of the patients in the comparison group, the following parameters were noteworthy: increased ESR (above 20 mm/h), decreased vitamin D₃ (mean level 36.4 (23.8–48.9) ng/ml), FSH above the age reference (mean value 45.4 (40–66.5) mIU/ml). An increase in leptin (mean value 9.0 (5.0–18.2) ng/ml) was noted, as well as SHBG (mean value 96.0 (78.3–117) nmol/l) (see Table 3).

The patients in the comparison group were treated in the gynecological department of the Perm Regional Clinical Hospital for stress urinary incontinence or pelvic organ dysfunction (vaginal wall prolapse, partial or complete uterine prolapse); no cases of chronic salpingitis, endometrial pathology, uterine leiomyoma, endometriosis or chronic cervicitis were detected in this group.

It is noteworthy that postmenopausal women who did not suffer from ovarian tumors (comparison group) did not have a history of chronic salpingitis, cervicitis, adenomyosis and leiomyoma – these gynecological diseases were detected only in patients with ovarian tumors (main group).

The following differences were recorded in the laboratory parameters in the main and comparison groups: the main group had higher mean values ​​of FSH, leptin and SHBG than the comparison group. Mean values ​​of vitamin D were lower in the main group.

Conclusions

Postmenopausal patients with benign ovarian tumors have a complicated gynecological history of inflammatory pathology of the fallopian tubes and cervix, proliferative pathology of the uterus; they have higher levels of FSH, SHBG, and leptin, as well as lower levels of vitamin D than postmenopausal women without ovarian tumors.

About the authors

Yu A. Shashurina

Perm Regional Clinical Hospital

Author for correspondence.
Email: jusya15@yandex.ru

Degree Candidate of the Department of Obstetrics and Gynecology №1, Obstetrician-gynecologist

Russian Federation, Perm

E. G. Kobaidze

E.A. Vagner Perm State Medical University

Email: jusya15@yandex.ru
ORCID iD: 0000-0001-5042-1549
SPIN-code: 1585-3296

DSc (Medicine), Professor of the Department of Obstetrics and Gynecology №1

Russian Federation, Perm

References

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