Impact of Coexisting Uterine Adenomyosis on the Survival Outcome of Patients with Endometrial Cancer: A Retrospective Cohort Study

Abstract

Objective:To determine the effects of uterine adenomyosis on endometrial cancerrecurrence rates. Methods: This retrospective cohort study reviewed all consecutive patients diagnosed with endometrial cancerwho underwent total hysterectomy-based surgical staging at Srinagarind Hospital between January, 2010 and January, 2016. The patientswere divided into two groups:a uterine adenomyosisgroup and a non-adenomyosis group. Patient demographics, type of surgery, histopathology, stage of endometrial cancer, adjuvant treatment, and survival outcomes were compared. Results: A total 350 patients were enrolled, with 132 (37.71%) in the adenomyosis group and 218 (62.29%) in the nonadenomyosis group. Deep myometrial invasion and lymphovascular space invasion (LVSI) were more commonly found among patients who had no adenomyosis compared to those with adenomyosis(52.8% vs 39.4%, P=0.02 and 53.2% vs. 38.6%, P=0.01). There were no significant differences in terms of five-year recurrence-free survival (HR=1.47; 95%CI 0.88-2.44) and five-year overall survival (HR=0.81; 95%CI 0.43-1.53) between the two comparison groups. Conclusion: Coexisting uterine adenomyosis in endometrial cancer wasassociated withdeep myometrial invasion and LVSI but did not have significant impact on survival.

Prevalence of adenomyosis in endometrial cancer patients: a systematic review and meta-analysis

“…13 articles remained after abstracts screening, and were assessed for eligibility. Finally, eight studies were included in the qualitative and quantitative analyses [6][7][8][9][10][11][12][13] (Fig. 1).…”

“…Several studies have assessed the histological co-existence of endometrial carcinoma (EC) and adenomyosis reporting different data [6][7][8][9][10][11][12][13]. The two pathologies share common etiopathogenetic mechanisms including unopposed hyper-oestrogenic state, inflammatory milieu and molecular features favoring cell proliferation and inflammation [14][15][16][17][18][19][20].…”

“…The two pathologies share common etiopathogenetic mechanisms including unopposed hyper-oestrogenic state, inflammatory milieu and molecular features favoring cell proliferation and inflammation [ 14 – 20 ]. According to some authors, adenomyosis could promote EC and affect pathological factors impacting on EC prognosis [ 7 , 8 , 11 ]. In fact, EC with adenomyosis has been associated with better overall survival, early International Federation of Gynaecology and Obstetrics (FIGO) stage and low FIGO grade [ 7 , 8 ].…”

Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis

“…In previous studies, adenomyosis coexisted with endometrial cancer in 0-70% 14 of cases, which is consistent with the studies we included 6.4-66% of cases. 4,[8][9][10][11][12][15][16][17][18][21][22][23][24] Furthermore, a population-based study comprising 768 patients with adenomyosis alone exhibited a fivefold increased risk of developing endometrial cancer. 25 Despite the common context, the mechanism of action of adenomyosis in endometrial cancer remains elusive.…”

“…[13][14] Conversely, co-existent adenomyosis in endometrial cancer has no impact on survival outcomes according to some studies. [15][16][17][18] Nevertheless, there exists a conflict regarding the influence of adenomyosis on the prognosis of endometrial cancer, with studies reporting conflicting results. Therefore, we conducted this metaanalysis to assess the effects of the coexistence of adenomyosis on the prognosis of endometrial cancer.…”