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

Abstract

Objective Published data on the impact of co‐existent adenomyosis on the prognosis of patients with endometrial cancer remains elusive, with studies reporting conflicting results. We conducted this meta‐analysis to evaluate the prognostic significance of co‐existent adenomyosis on clinical outcomes and tumor characteristics of endometrial cancer patients. Methods A comprehensive literature review of multiple databases was conducted; quality assessment of eligible studies was performed by the Newcastle‐Ottawa scale (NOS). The outcomes of interest were compared in endometrial cancer patients with or without adenomyosis. Hazards ratios (HR) and Odds ratios (OR) with 95% confidence interval (CI) were calculated as a measure of effects. Results Fourteen retrospective observational studies comprising 1308 endometrial cancer patients with adenomyosis and 3734 patients without adenomyosis were included in this meta‐analysis. Results indicated that endometrial cancer patients with adenomyosis was significantly associated with an increased overall survival rate (HR = 0.51; 95% CI = 0.38–0.69; P < 0.00001), but not with disease‐free survival rate (HR = 0.68; 95% CI = 0.30–1.53; P = 0.35); besides, significantly associated with decreased ratio of deep myometrial invasion (OR = 0.45; 95% CI = 0.33–0.60; P < 0.00001), lymphovascular space invasion (OR = 0.44; 95% CI = 0.29–0.68; P = 0.0002), an increased ratio of histological grade 1 (OR = 1.84; 95% CI = 1.34–2.53; P = 0.0002) and FIGO I‐II (OR = 1.85; 95% CI = 1.49–2.30; P < 0.00001). However, there was no significant difference in pathological type and lymph node metastasis. There was a low to high heterogeneity with I2 ranging from 0 to 67%. Conclusion This meta‐analysis indicated that co‐existent adenomyosis with endometrial cancer is associated with favorable tumor characteristics and could serve as a potential protective factor for the prognosis of endometrial cancer.

Endometrial cancer prognosis in women with endometriosis and adenomyosis: A retrospective nationwide cohort study of 40 840 women

“…A recent meta‐analysis found an increased overall survival with a crude HR of 0.51 (95% CI 0.38‐0.69) in 855 women with endometrial cancer and histologically proven adenomyosis, which was similar to our crude HR of 0.63 (95% CI 0.59‐0.69) 7 . They concluded that women with endometrial cancer and adenomyosis had a decreased ratio of deep myometrial invasion, less often had LVSI, more often had low‐grade cancer and early cancer stage.…”

Adenomyosis as a Risk Factor for Myometrial or Endometrial Neoplasms—Review

“…Conversely, An M et al, in their meta-analysis, also indicated that coexistent adenomyosis with endometrial cancer (EC-A) is associated with a favorable prognosis compared to EC. They found a better overall survival rate in EC-A, decreased ratio of Ib according to FIGO (deep myometrial invasion) (OR = 0.45; 95% CI = 0.33–0.60; p < 0.00001) or lymphovascular space invasion [ 57 ]. Worth mentioning is the fact that only parity and not other risk factors for EC differs between patients with EC coexisting with adenomyosis and EC alone [ 58 ].…”

Impact of adenomyosis on the prognosis of patients with endometrial cancer

“…Several hypotheses have been proposed to explain the poor prognosis in EC patients with adenomyosis. The large contact area between ectopic endometrium of adenomyosis and the muscular layer might increase the incidence and depth of myometrial infiltration of EC [22,32,33]. Furthermore, EC might follow the spread mechanism of ectopic endometrium through lymph and veins, increasing lymphovascular space invasion [22,34].…”

“…The large contact area between ectopic endometrium of adenomyosis and the muscular layer might increase the incidence and depth of myometrial infiltration of EC [22,32,33]. Furthermore, EC might follow the spread mechanism of ectopic endometrium through lymph and veins, increasing lymphovascular space invasion [22,34]. In addition, the poor prognosis of EC patients with adenomyosis has been associated with the malignant transformation of adenomyosis [35,36].…”

“…On the contrary, no difference was found in terms of disease-free survival (DFS). However, some studies included in the meta-analysis only included EC patients with an endometrioid histotype [22]. As the endometrioid histotype shows the best prognosis in EC patients [17,23], the results from this meta-analysis may be affected by this patient selection.…”