{"paper_id":"b4860ae5-ea2e-4a76-bfef-8fb8275f9e68","body_text":"Impact of Uterine Adenomyosis on Survival Outcome of Patients with Non-Endometrioid Endometrial Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Uterine Adenomyosis on Survival Outcome of Patients with Non-Endometrioid Endometrial Cancer Levent Ozgen, Yakup Yalcin, Merve Abay, Kemal Ozerkan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4803752/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Oct, 2025 Read the published version in BMC Cancer → Version 1 posted 4 You are reading this latest preprint version Abstract Background The impact of the presence of adenomyosis on survival in patients with non-endometrioid endometrial cancer (EC) remains unclear.The aim of this study is to compare the effect of the presence or absence of histologically proven adenomyosis on the survival of patients with non-endometrioid EC. Methods We identified all patients who were consecutively diagnosed with non-endometrioid EC and underwent surgery in a single center between May 1998 and March 2023. Patients with insufficient clinical or surgical data were excluded from the study. A total of 139 non-endometrioid EC patients in the study were divided into two groups as with and without adenomyosis. Demographic characteristics and clinical findings such as age, BMI, menopausal status and pathologic variables such as presence of adenomyosis, tumor grade, depth of myometrial invasion, lymphovascular space involvement, lymph node status, and distant spread were obtained hospital records.Kaplan Meier analysis was performed for survival analysis. Overall (OS), and disease-free survival (DFS) were calculated. Results A total of 139 patients, 40 (28.7%) in the adenomyosis group and 99 (71.3%) in the non-adenomyosis group, were included in the study and their data were recorded.There was no significant difference between patients with non-endometrioid type EC with and without adenomyosis in terms of patient demographic characteristics and pathological variables (p > 0.05).When the patients in the adenomyosis and non-adenomyosis groups were compared, there was no statistically significance regarding recurrence time (175.2 ± 24.4 months vs 95.1 ± 11.2 months, p = 0.166). However, OS was found to be statistically significantly higher in patients with adenomyosis than in those without adenomyosis (172 ± 24.1 months vs 102 ± 13.9 months; p = 0.02). Conclusions The presence of adenomyosis in non-endometrioid type endometrial cancer was not associated with pathological variables such as myometrial invasion, tumor diameter and lympho-vascular space involvement. Although DFS and cancer-related death rates were similar, OS was significantly higher in the presence of adenomyosis. adenomyosis disease free survival non-endometrioid endometrial cancer overall survival Figures Figure 1 INTRODUCTION Endometrial cancer (EC) is the most common gynecological malignancy in developing countries. Its incidence in women is approximately 2.5-3%, and the mortality rate is reported to increase by an average of 1.9% per year. The standard approach to the treatment of endometrial cancer is surgery, including total hysterectomy with bilateral salpingo-oophorectomy and either sentinel node biopsies or lymphadenectomy in women at high risk for nodal metastases [ 1 , 2 ]. Endometrial carcinomas include a variety of types with different prognosis and traditionally it has been classified according to its histomorphological features. Estrogen-induced type 1 endometrioid carcinomas (endometrioid type) are more common and account for 70–80% of cases, while non-estrogen-induced type 2 endometrioid carcinomas (non-endometrioid endometrial carcinomas) are less common and exhibit more aggressive behavior [ 3 ]. Adenomyosis is characterized by the presence of endometrial epithelium and stroma in the muscular layer of the uterus. The frequency of adenomyosis is around 20–30% in cases of hysterectomy performed for benign reasons and similarly 22.6% in patients with endometrial cancer [ 4 ]. The pathogenetic mechanisms in the development of endometrial cancer are similar to benign lesions such as endometriosis and adenomyosis. These common mechanisms include hormone dependency, genetic predisposition, similarity in growth and environmental factors, inflammation and alteration of the immune system [ 5 ]. The presence of adenomyosis, one of the most common additional histopathologic findings in endometrial cancer, has been found to be associated with better overall survival, earlier stage and lower grade, indicating a better prognosis in patients with endometrioid EC. However, there is still uncertainty about the relationship between the presence of adenomyosis and prognosis in patients with non-endometrioid EC [ 6 , 7 ]. The aim of this study was to evaluate the effect of the presence of adenomyosis on overall survival (OS) and disease-free survival (DFS) in the less common but poorly progressive non-endometrioid EC. MATERIALS AND METHODS This retrospective cross-sectional cohort study was carried out in the Department of Gynecologic Oncology at Bursa Uludag University Hospital. We identified all patients with consecutive diagnosis of EC who underwent surgery at a single center between May 1998 and March 2023.Within the scope of the study, the files of the patients and the information on the hospital information management system and the patients from the Ministry of Health Death Notification System were scanned retrospectively. A total of 815 endometrial cancer (endometrioid and non-endometrioid) patients were identified. One hundred fifty-seven patients with insufficient surgery, insufficient clinical or surgical data, any other tumor metastasized to the endometrium, or a history of synchronous tumors were excluded from the study. A total of 139 patients with a diagnosis of non-endometrioid EC who met the study criteria were examined in the pathology reports. All pathological specimens were prepared and examined by the gynecological pathologists in our hospital. Patients were divided into 2 subgroups according to the presence or absence of adenomyotic tissue. Demographic characteristics of the patients, such as age, parity, body mass index (BMI), menopausal status, diabetes and hypertension, were documented from hospital records.The type of operation performed (hysterectomy, pelvic/paraaortic lymphadenectomy (+-) and omentectomy (+-), presence or absence of adjuvant therapy, chemotherapy (CT), radiotherapy (RT) and/or chemoradiotherapy (CRT) were recorded. Postoperative histopathological final diagnosis and the type of carcinoma, stage of the disease, tumor diameter, tumor grade, depth of myometrial invasion, cervical stromal invasion, lympho-vascular space invasion (LVSI), adnexal involvement, presence of lymph node involvement, peritoneal fluid cytology, preoperative cancer antigen CA-125 levels were evaluated and the information was recorded. Overall survival (OS), disease free survival (DFS), recurrence time and presence of mortality were evaluated using the hospital information system program and the data were recorded. The study was conducted in accordance with the principles of the Declaration of Helsinki. It was obtained by the local ethics committee (Date: 28/02/2022 Decision No: 2011-KAEK-26/118). Statistical analysis Data analysis was performed with SPSS (statistic package for social sciences, Chicago, IL, USA) 22.0 package program. Descriptive statistics were presented as mean ± standard and median (minimum-maximum) for continuous variables, and as numbers and percentages for categorical variables. Whether the distribution of continuous variables was close to normal was evaluated with the Shapiro Wilk test. In cases where parametric conditions were met, the difference of continuous variables between the two groups was evaluated with the Independent simple t test, and in cases where parametric conditions were not met, with the Mann Whitney U test. Kaplan Meier analysis was performed for survival analysis. Ap < 0.05 level was considered significant. RESULTS Data of 139 patients who underwent surgery for non-endometrioid EC were analyzed in the study.It was determined that 28.7% (n = 40) of the patients had adenomyosis and 71.3% (n = 99) did not have adenomyosis. Table 1 shows the demographic and clinical characteristics of the entire study population.The median age of the total population included in the study was 66 [40–88] years old, 97.8% (n = 136) were in the postmenopausal period.The median BMI of the total patient population was 32.6 [20-51.9] kg/m 2 .When the stage of the total patient group was examined, 38.8% were found to be stage 1a, 12.9% were stage 1b, 6.5% were stage 2 and 41.7% were stage 3 ≥ and above.The median value of preoperative Ca-125 levelin the totally study group was 27.4 (4-1885) IU/ml. Hysterectomy alone was performed in 12.2% of patients. 5.8% underwent hysterectomy and pelvic lymphadenectomy, and 82% underwent hysterectomy with pelvic/paraaortic lymphadenectomy.While 5.8% of the patients did not receive adjuvant treatment, 13.7% received CT, 24.5% received RT, and 56.1% received CRT.There was no significant difference between the groups with and without adenomyosis in terms of age, BMI, comorbidities, menopausal status, Ca-125 level, type of surgery performed, omentectomy, stage and adjuvant treatment (p > 0.05). Table 1 Demographic characteristic findings and surgery type of patients DM, diabetes mellitus; HT, hypertension Characteristics Total Population (n = 139) Median or number (%) Adenomyosis (n = 40) Median or number (%) Non-adenomyosis (n = 99) Median or number (%) P Age, years 66 (40–88) 65.5 (48–88) 66 (40–86) 0.885 BMI, kg/m 2 32.6 (20-51.69) 33.5 (21–44) 32.5 (20-51.6) 0.235 Other diseases None DM HT DM + HT 10 (7.19) 11 (7.91) 73 (52.51) 45 (32.37) 2 (5) 4 (10) 24 (60) 10 (25) 8 (8.1) 7 (7.1) 49 (49.5) 35 (35.4) 0.546 Menapouse Status Postmenopausal Premenopausal 136 (97.8) 3 (2.2) 40 (100) 0 (0) 96 (97) 3(3) 0.557 CA-125, IU/L 24.7 (4-1885) 17.5 (7.2–330) 28.8 (4-1885) 0.119 Type of surgery Hysterectomy Hysterectomy + PLND Hysterectomy + PPLND 17 (12.2) 8 (5.8) 114 (82) 4 (10) 3 (7.5) 33 (82.5) 13 (13.1) 5 (5.1) 81 (81.8) 0.756 Omentectomy Yes No 122 (87.8) 17 (12.2) 36 (90) 4 (10) 86(86.9) 13 (13.1) 0.778 Stage 1a 1b 2 ≥ 3 47 (38.8) 25 (12,9) 9 (6.5) 58 (41.7) 16 (40) 5 (12.5) 2 (5) 17 (42.5) 31 (31.3) 20 (20.2) 7 (7.1) 41 (41.4) 0.621 Adjuvan treatment None KT RT KRT 8 (5.8) 19 (13.7) 34 (24.5) 78 (56.1) 2 (5) 8 (20) 9 (22.5) 21 (52.5) 6 (6.1) 11 (11.1) 25 (25.3) 57 (57.6) 0.890 Data are given as median or n (%). P<0.05 accepted as statistically significant. Data in boldfont indicates statistically significant values. BMI: Body Mass Index, DM: diabetes mellitus; HT: hypertension, PLND: pelvic lymph node dissection, PPLND: pelvic and para-aortic lymph node dissection, KT: chemotherapy, KRT: chemoradiotherapy . The most common histological type in the study group was serous EC with 38.8%. There was no difference between the groups in terms of histological types (p = 0.147).More than half of myometrial invasion was detected in 35% of the patients in the adenomyosis group and in 45.5% of the patients in the non-adenomyosis group.No statistically significant difference was found between both groups(p = 0.259). Similarly, no significant difference was found between adenomyotic and non-adenomyotic EC patients in the analysis of cervical stromal invasion, lympho-vascular space invasion, positive peritoneal fluid cytology, tumor size, omental metastasis and lymph node metastasis, which are poor prognostic indicators for EC (p = 0.926, p = 0.307, p = 0.511, p = 0.360, p = 0.238 and p = 0.717, respectively). The pathological findings of the patients are presented in Table 2 . Table 2 Pathological findings of patients Data are given as median or n (%). P < 0.05 accepted as statistically significant Characteristics Total Population (n = 139) Median or number (%) Adenomyosis (n = 40) Median or number (%) Non-adenomyosis (n = 99) Median or number (%) P Hystological type Serous Mucinous Clear cell Carcinocarcoma Undifferentiated Mixt type 54 (38.8) 14 (10.1) 17 (12.2) 31 (22.3) 16 (11.5) 7 (5) 16 (40) 5 (12.5) 5 (12.5) 4 (10) 8 (20) 2 (5) 38 (38.4) 9 (9.1) 12 (12.1) 27 (27.3) 8 (8.1) 5 (5.1) 0.147 Myometrial invasion < 1/2 ≥ 1/2 80 (57.6) 59 (42.4) 26 (65) 14 (35) 54 (54.5) 45 (45.5) 0.259 Cervical stromal invasion Yes No 32 (23) 107 (77) 9 (22.5) 31 (77.5) 23 (23.2) 76 (76.8) 0.926 Lymphovascular space invasion Yes No 81 (58.3) 58 (41.7) 26 (65) 14 (35) 55 (55.6) 44 (44.4) 0.307 Tumor size, cm 4 (0.4–15.3) 3.75 (0.5–10.5) 4 (0.4–15.3) 0.360 Peritoneal fluid cytology Negative Positive 128 (92.1) 11 (7.9) 38 (95) 2 (5) 90 (90.9) 9 (9.1) 0.511 Omental metastasis Yes No 16 (11.5) 123 (88.5) 7 (17.5) 33 (82.5) 9 (9.1) 90 (90.9) 0.238 Lymph node metastasis No Pelvic Paraaortic Pelvic + paraaortic 104 (74.8) 6 (4.3) 5 (3.6) 24 (17.3) 33 (82.5) 1 (2.5) 1 (2.5) 5 (12.5) 71 (71.7) 5 (5.1) 4 (4) 19 (19.2) 0.717 Data are given as median or n (%). P<0.05 accepted as statistically significant Mortality occurred in 56.83% (n = 79) of the total population during follow-up in the study group. While 78.4% (n = 62) of these patients were in the non-adenomyosis group, 21.6% (n = 17) were in the adenomyosis group. The difference was not statistically significant (p = 0.537). The mean overall survival time of the total study group during follow-up was 125.1 ± 13.1 months while this period was 172 ± 24.1 months in the adenomyosis group and 102 ± 13.9 months in the non-adenomyosis group. There was a statistically significant difference between the groups in favor of EC patients with adenomyosis coexistence (p = 0.021). The duration of recurrence in the total group was 137 ± 13.8 months. Although this period was longer than the mean recurrence time of 175.2 ± 24.4 months in the group with adenomyosis and 95.1 ± 11.2 months in the non-adenomyotic group, it did not make a statistically significant difference (p = 0.166). The recurrence and survival times of the patients are shown in Table 3. Progression-free survival by time in adenomyotic and non-adenomyotic groups in patients with EC is shown in Fig. 1 a, and overall survival is shown in Fig. 1 b. Table 3 . Recurrence and survival time of patients Characteristics Total Population Mean + SD or number (%) Adenomyosis Mean + SD or number (%) Non-adenomyosis Mean + SD or number (%) P Recurence time, mounth 137.3 + 13.8 175.2 + 24,4 95.1 + 11.2 0.166 Overall survival time, mounth 125.1 + 13.1 172.7 + 24.1 102.2 + 13.9 0.021 Death related to EC Yes No 79 58 (73.4) 21 (26.6) 17 14 (82.4) 3 (17.6) 62 44 (71) 18 (29) 0.537 Data in boldfont indicates statistically significant values. Data are given as mean + SD or n (%). P < 0.05 accepted as statistically significant. DISCUSSION Several hypotheses have been proposed to explain the good prognosis in EC patients with adenomyosis. Increased levels of the antitumoral cytokines such as interferon-γ, tumor necrosis factor-α and interleukin 10 in adenomyosis tissue and decreased levels of oncogenic cytokines interleukin 1-beta, interleukin 8, epidermal growth factor and transforming growth factor create a protective effect. Another hypothesis is that adenomyosis blocks cancer invasion by mechanically contributing to the surrounding hypertrophic and hyperplastic myometrial stroma [ 6 ]. On the contrary, some mechanisms may support the poor prognostic effect of adenomyosis. One of them is that the large contact area between the ectopic endometrium layer and the uterine muscle layer in adenomyosis can increase the depth of myometrial infiltration of EC. The other is that ectopic endometrium can increase the invasion of the lympho-vascular area by following the mechanism of spread through lymph and vessels [ 8 ]. The literature also provides evidence for direct malignant transformation of adenomyosis. Endometrial Cancer caused by adenomyosis, which constitutes less than 1% of EC, originates from the epithelium of adenomyotic foci located between the muscle fibers of the uterine myometrium. A comparison of endometrial cancer arising in adenomyosis (EC-AIA) and endometrial cancer coexisting with adenomyosis (EC-A) concluded that EC-AIA is associated with poor survival [ 6 , 9 – 10 ]. The clinical significance of the association of adenomyosis and endometrial cancer has not been clearly established. Although the presence of adenomyosis has been shown to be associated with better overall survival, earlier stage and lower FIGO grade in patients with endometrioid type EC, there is still uncertainty about the prognosis for patients with non-endometrioid endometrial cancer. To our knowledge, there are a few studies in the literature on the relationship between non-endometrioid EC and adenomyosis [ 11 – 14 ]. Due to the limitations of studies in the literature, in this study we tried to determine whether the presence of adenomyosis has a positive or negative prognostic effect on OS and DFS in patients with non-endometrioid EC. According to Raffone et al.'s analysis of eight retrospective cohort studies evaluating 5573 EC patients to better understand the prevalence, histological association and relationship between endometrial carcinoma and adenomyosis, the pooled adenomyosis prevalence was found to be 22.6%.This result revealed that the prevalence of adenomyosis in EC patients was not different from that reported for other gynecological conditions. Also, EC patients with adenomyosis have a significantly reduced risk for adverse histologic prognostic factors of EC compared to EC patients without adenomyosis. Such findings may explain the proposed better EC prognosis in patients with adenomyosis [ 4 ]. In a recent meta-analysis by An et al., based on 14 retrospective observational studies including 1308 patients withEC with adenomyosis and 3734 patients with ECwithout adenomyosis, a positive increase in OS was observed in patients with adenomyosis, but no difference in DFS was observed between the two groups. It was also observed that patients with adenomyosis were younger, had less deep MI, less LVSI positivity, and more grade 1 and FIGO I-II stages. It has been reported that there is no significant difference in terms of histologic type and lymph node metastasis [ 15 ]. In our study, no difference was found in terms of prognostic factors. The results of another meta-analysis showed that it significantly increased OS in EC patients with concomitant adenomyosis, but unlike most studies, there was no difference in DFS. However, some of the studies comprising this meta-analysis included only EC patients with endometrioid histologic type. Since endometrioid histologic type is the group with the best prognosis in EC patients, the results of the current meta-analysis may have been affected by this patient selection [ 8 ]. Matsuo et al., in their study including stage 1–4 EC patients, stated that the adenomyosis group was at an earlier stage and the probability of myometrial invasion and cervical invasion was lower. Furthermore, significantly better DFS and OS were reported in the EC group with adenomyosis in this study. When both disease-free survival and overall survival time between the endometrioid and non-endometrioid groups were evaluated, it was found that both were better in the endometrioid group. An independent effect of adenomyosis could not be demonstrated in multivariate analysis. No subgroup analysis was performed in terms of survival between patients with and without adenomyosis in the non-endometrioid group [ 11 ]. In our study, the OS in the adenomyosis group was 172 ± 24.1 months, which was significantly better than the mean OS of the non-adenomyotic EC group, which was 102 ± 13.9 months. However, we did not detect any difference in DFS between the adenomyotic and non-adenomyotic groups in our study. Sanci et al. evaluated the effect of adenomyosis on overall survival and prognostic histopathological factors in 400 EC patients. The study found no difference between the 2 groups in terms of disease-free survival and death from cancer. However, multivariate analysis revealed an independent positive effect of adenomyosis on overall survival [ 13 ]. Since the number of non-endometrioid patients in the study was only 25, adenomyosis and non-adenomyosis subgroup analysis could not be performed in this group. In the study of Çelik et al., both endometrioid and non-endometrioid EC types were included. Sub-analysis was performed to show the impact of different histological types on the results and a significant difference in the reduction of mortality was found in endometrioid type EC. There was no difference in disease-free survival and disease-related death between non-endometrioid type EC with and without adenomyosis. Disease-specific survival was significantly longer in patients with adenomyosis in the entire patient group, but progression-free survival was not affected by the presence of adenomyosis. These patients with coexistent adenomyosis and EC had better clinicopathological features and less advanced tumors. However, in multivariate analysis, adenomyosis was not found to be an independent prognostic factor for EC [ 14 ]. In our study, there was no significant difference between the adenomyosis group and the non-adenomyosis group in terms of these negative prognostic indicators. One of the strengths of our study is that it includes a larger number of patients compared to studies in the literature where the number of patients with non-endometrioid endometrial cancer is limited. A significant contribution has been made to the literature on this subject, which contains contradictory evidence. All patients were operated on at a single center and pathological samples were evaluated by experienced gynecological pathologists. The retrospective design can be considered a limitation of our study. CONCLUSION In conclusion, this study showed that the presence of adenomyosis was only significantly associated with higher overall survival in non-endometrioid EC. This result revealed in our study highlights that the presence of adenomyosis should be considered as a good prognostic factor in all EC types, including non-endometrioid endometrial cancer. Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author’s Information Levent Ozgen 1 , Yakup Yalcin 1 , Merve Abay 1 , Kemal Ozerkan 1 Author’s and affiliations Levent Ozgen 1 , Yakup Yalcin 1 , Merve Abay 1 , Kemal Ozerkan 1 1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Bursa Uludag, Bursa, Turkey Contributions LO., project development, data collection, manuscript writing, supervision. YY., project development, manuscript writing, supervision. MA., data collection, ınvestigation. KO.,manuscript writing, supervision. Corresponding Author: Yakup Yalcin, [email protected] Ethics declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University UludagcMedicine Faculty (Date: 28/02/2022 Decision No: 2011-KAEK-26/118). Informed consent was obtained from all individual participants included in the study. Competing interests The authors declare no competing interests. References Wang J, Wang Q, Wang W, Yang J, Xia J, Wei Y. Endometrioid adenocarcinoma arising in adenomyosis in a patient with pelvic organ prolapse—case report. BMC Womens Health. 2023;23(1):150. 10.1186/s12905-023-02310-6 . Oaknin A, Bosse TJ, Creutzberg CL, Giornelli G, Harter P. Endometrial cancer: ESMO Clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(9):860–77. 10.1016/j.annonc.2022.05.009 . Ko EM, Walter P, Clark L, Jackson A, Franasiak J, Bolac C, et al. The Complex Triad of Obesity, Diabetes and Race in Type I and II Endometrial Cancers: Prevalence and Prognostic Significance. Gynecol Oncol. 2024;133(1):28–32. 10.1016/j.ygyno.2014.01.032 . Raffone A, Seracchioli R, Raimondo D, Maletta M, Travaglino A, Ivano Raimondo I, et al. 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Rev Assoc Med Bras. 2023;69:e20221720. 10.1590/1806-9282.20221720 . Sanci M, Erkilinç S, Taylan E, Gülseren V, Erkilinç G, Karadeniz T, et al. The effect of adenomyosis in myometrial invasion and overall survival in endometrial cancer. Int J Gynecol Cancer. 2018;28(1):145–51. 10.1136/IGC.0000000000001137corr1 . Celik E, Goksever Celik H, Sozen H, Onder S, Tosun OA, Topuz S, et al. The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study. J Obstet Gynaecol Res. 2022;42(1):158–65. 10.1080/01443615.2021.1980508 . An M, Duan H, Zhang Y. Prognostic significance of co-existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: a meta‐analysis. J Obstet Gynaecol Res. 2020;46(9):1851–63. 10.1111/jog.14371 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Oct, 2025 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 01 Aug, 2024 Editor assigned by journal 01 Aug, 2024 Submission checks completed at journal 26 Jul, 2024 First submitted to journal 25 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4803752\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":334909431,\"identity\":\"d01d6fe1-7029-4234-b657-e179369dd446\",\"order_by\":0,\"name\":\"Levent Ozgen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Uludağ University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Levent\",\"middleName\":\"\",\"lastName\":\"Ozgen\",\"suffix\":\"\"},{\"id\":334909432,\"identity\":\"54bb2ff2-4683-4022-ad1f-780e86850cb6\",\"order_by\":1,\"name\":\"Yakup Yalcin\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYDCCAwwMjA0gBjuIXQFkMDM3EKmFGcQ+A2IwkqCFgbENxCKghe/2GcOPM9vuJPY3Mz88XDivNpq/HajlR8U2nFokz+UYS25se5Y44zCbweGZ247nzjjM2MDYc+Y2Ti0GZ3gMJB+2HU5sOMzDcJh327HcBqAWZsY2vFqMf4K0zAdrmXMsdz4RWsyADjucuAGspaEmdwMhLZJn2MosZ5x7ZrwR5BeeYwdyNwK1HMTnF74zzJtv9pTdkZ13vPnxZ56autx55w8ffPCjArcWBgYOAyBxwLEBwjsMJg/gUQ8E7A9AauyhvDr8ikfBKBgFo2BEAgDK92deEvYAaAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Uludağ University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Yakup\",\"middleName\":\"\",\"lastName\":\"Yalcin\",\"suffix\":\"\"},{\"id\":334909433,\"identity\":\"87672fbd-7823-4adf-8fad-f1b754d60a71\",\"order_by\":2,\"name\":\"Merve Abay\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Uludağ University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Merve\",\"middleName\":\"\",\"lastName\":\"Abay\",\"suffix\":\"\"},{\"id\":334909434,\"identity\":\"193792a8-f1d5-49fa-8361-d2649e07d026\",\"order_by\":3,\"name\":\"Kemal Ozerkan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Uludağ University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kemal\",\"middleName\":\"\",\"lastName\":\"Ozerkan\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-07-25 18:33:24\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4803752/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4803752/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12885-025-14815-4\",\"type\":\"published\",\"date\":\"2025-10-14T15:58:18+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":63417720,\"identity\":\"aa2cc6ad-1125-426e-8b94-f9e02542de09\",\"added_by\":\"auto\",\"created_at\":\"2024-08-28 02:05:56\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":24843,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ea. Progression Free Survival\\u003c/p\\u003e\\n\\u003cp\\u003eb. Overall Survival\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4803752/v1/ea9cc0d45316fcd0e48fd0b5.png\"},{\"id\":93956204,\"identity\":\"72a2542d-11d6-4224-aaa1-91d9f880b76f\",\"added_by\":\"auto\",\"created_at\":\"2025-10-20 16:11:30\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":833880,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4803752/v1/f5e1fdb1-09b3-4b0b-8295-706b315f9c09.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Impact of Uterine Adenomyosis on Survival Outcome of Patients with Non-Endometrioid Endometrial Cancer\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eEndometrial cancer (EC) is the most common gynecological malignancy in developing countries. Its incidence in women is approximately 2.5-3%, and the mortality rate is reported to increase by an average of 1.9% per year. The standard approach to the treatment of endometrial cancer is surgery, including total hysterectomy with bilateral salpingo-oophorectomy and either sentinel node biopsies or lymphadenectomy in women at high risk for nodal metastases [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eEndometrial carcinomas include a variety of types with different prognosis and traditionally it has been classified according to its histomorphological features. Estrogen-induced type 1 endometrioid carcinomas (endometrioid type) are more common and account for 70\\u0026ndash;80% of cases, while non-estrogen-induced type 2 endometrioid carcinomas (non-endometrioid endometrial carcinomas) are less common and exhibit more aggressive behavior [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdenomyosis is characterized by the presence of endometrial epithelium and stroma in the muscular layer of the uterus. The frequency of adenomyosis is around 20\\u0026ndash;30% in cases of hysterectomy performed for benign reasons and similarly 22.6% in patients with endometrial cancer [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The pathogenetic mechanisms in the development of endometrial cancer are similar to benign lesions such as endometriosis and adenomyosis. These common mechanisms include hormone dependency, genetic predisposition, similarity in growth and environmental factors, inflammation and alteration of the immune system [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe presence of adenomyosis, one of the most common additional histopathologic findings in endometrial cancer, has been found to be associated with better overall survival, earlier stage and lower grade, indicating a better prognosis in patients with endometrioid EC. However, there is still uncertainty about the relationship between the presence of adenomyosis and prognosis in patients with non-endometrioid EC [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe aim of this study was to evaluate the effect of the presence of adenomyosis on overall survival (OS) and disease-free survival (DFS) in the less common but poorly progressive non-endometrioid EC.\\u003c/p\\u003e\"},{\"header\":\"MATERIALS AND METHODS\",\"content\":\"\\u003cp\\u003eThis retrospective cross-sectional cohort study was carried out in the Department of Gynecologic Oncology at Bursa Uludag University Hospital. We identified all patients with consecutive diagnosis of EC who underwent surgery at a single center between May 1998 and March 2023.Within the scope of the study, the files of the patients and the information on the hospital information management system and the patients from the Ministry of Health Death Notification System were scanned retrospectively.\\u003c/p\\u003e \\u003cp\\u003eA total of 815 endometrial cancer (endometrioid and non-endometrioid) patients were identified. One hundred fifty-seven patients with insufficient surgery, insufficient clinical or surgical data, any other tumor metastasized to the endometrium, or a history of synchronous tumors were excluded from the study. A total of 139 patients with a diagnosis of non-endometrioid EC who met the study criteria were examined in the pathology reports.\\u003c/p\\u003e \\u003cp\\u003eAll pathological specimens were prepared and examined by the gynecological pathologists in our hospital. Patients were divided into 2 subgroups according to the presence or absence of adenomyotic tissue. Demographic characteristics of the patients, such as age, parity, body mass index (BMI), menopausal status, diabetes and hypertension, were documented from hospital records.The type of operation performed (hysterectomy, pelvic/paraaortic lymphadenectomy (+-) and omentectomy (+-), presence or absence of adjuvant therapy, chemotherapy (CT), radiotherapy (RT) and/or chemoradiotherapy (CRT) were recorded. Postoperative histopathological final diagnosis and the type of carcinoma, stage of the disease, tumor diameter, tumor grade, depth of myometrial invasion, cervical stromal invasion, lympho-vascular space invasion (LVSI), adnexal involvement, presence of lymph node involvement, peritoneal fluid cytology, preoperative cancer antigen CA-125 levels were evaluated and the information was recorded. Overall survival (OS), disease free survival (DFS), recurrence time and presence of mortality were evaluated using the hospital information system program and the data were recorded. The study was conducted in accordance with the principles of the Declaration of Helsinki. It was obtained by the local ethics committee (Date: 28/02/2022 Decision No: 2011-KAEK-26/118).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eData analysis was performed with SPSS (statistic package for social sciences, Chicago, IL, USA) 22.0 package program. Descriptive statistics were presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard and median (minimum-maximum) for continuous variables, and as numbers and percentages for categorical variables. Whether the distribution of continuous variables was close to normal was evaluated with the Shapiro Wilk test. In cases where parametric conditions were met, the difference of continuous variables between the two groups was evaluated with the Independent simple t test, and in cases where parametric conditions were not met, with the Mann Whitney U test. Kaplan Meier analysis was performed for survival analysis. Ap\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 level was considered significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eData of 139 patients who underwent surgery for non-endometrioid EC were analyzed in the study.It was determined that 28.7% (n\\u0026thinsp;=\\u0026thinsp;40) of the patients had adenomyosis and 71.3% (n\\u0026thinsp;=\\u0026thinsp;99) did not have adenomyosis.\\u003c/p\\u003e\\n\\u003cp\\u003eTable \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows the demographic and clinical characteristics of the entire study population.The median age of the total population included in the study was 66 [40\\u0026ndash;88] years old, 97.8% (n\\u0026thinsp;=\\u0026thinsp;136) were in the postmenopausal period.The median BMI of the total patient population was 32.6 [20-51.9] kg/m\\u003csup\\u003e2\\u003c/sup\\u003e.When the stage of the total patient group was examined, 38.8% were found to be stage 1a, 12.9% were stage 1b, 6.5% were stage 2 and 41.7% were stage 3\\u0026thinsp;\\u0026ge;\\u0026thinsp;and above.The median value of preoperative Ca-125 levelin the totally study group was 27.4 (4-1885) IU/ml. Hysterectomy alone was performed in 12.2% of patients. 5.8% underwent hysterectomy and pelvic lymphadenectomy, and 82% underwent hysterectomy with pelvic/paraaortic lymphadenectomy.While 5.8% of the patients did not receive adjuvant treatment, 13.7% received CT, 24.5% received RT, and 56.1% received CRT.There was no significant difference between the groups with and without adenomyosis in terms of age, BMI, comorbidities, menopausal status, Ca-125 level, type of surgery performed, omentectomy, stage and adjuvant treatment (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eDemographic characteristic findings and surgery type of patients DM, diabetes mellitus; HT, hypertension\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTotal Population\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;139)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAdenomyosis\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;40)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNon-adenomyosis\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;99)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge, years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e66 (40\\u0026ndash;88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e65.5 (48\\u0026ndash;88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e66 (40\\u0026ndash;86)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.885\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBMI, kg/m\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32.6 (20-51.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e33.5 (21\\u0026ndash;44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32.5 (20-51.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.235\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOther diseases\\u003c/p\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003cp\\u003eDM\\u003c/p\\u003e\\n \\u003cp\\u003eHT\\u003c/p\\u003e\\n \\u003cp\\u003eDM\\u0026thinsp;+\\u0026thinsp;HT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 (7.19)\\u003c/p\\u003e\\n \\u003cp\\u003e11 (7.91)\\u003c/p\\u003e\\n \\u003cp\\u003e73 (52.51)\\u003c/p\\u003e\\n \\u003cp\\u003e45 (32.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (5)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (10)\\u003c/p\\u003e\\n \\u003cp\\u003e24 (60)\\u003c/p\\u003e\\n \\u003cp\\u003e10 (25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8 (8.1)\\u003c/p\\u003e\\n \\u003cp\\u003e7 (7.1)\\u003c/p\\u003e\\n \\u003cp\\u003e49 (49.5)\\u003c/p\\u003e\\n \\u003cp\\u003e35 (35.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.546\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMenapouse Status\\u003c/p\\u003e\\n \\u003cp\\u003ePostmenopausal\\u003c/p\\u003e\\n \\u003cp\\u003ePremenopausal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e136 (97.8)\\u003c/p\\u003e\\n \\u003cp\\u003e3 (2.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e40 (100)\\u003c/p\\u003e\\n \\u003cp\\u003e0 (0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e96 (97)\\u003c/p\\u003e\\n \\u003cp\\u003e3(3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.557\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCA-125, IU/L\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e24.7 (4-1885)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17.5 (7.2\\u0026ndash;330)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e28.8 (4-1885)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.119\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eType of surgery\\u003c/p\\u003e\\n \\u003cp\\u003eHysterectomy\\u003c/p\\u003e\\n \\u003cp\\u003eHysterectomy\\u0026thinsp;+\\u0026thinsp;PLND\\u003c/p\\u003e\\n \\u003cp\\u003eHysterectomy\\u0026thinsp;+\\u0026thinsp;PPLND\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17 (12.2)\\u003c/p\\u003e\\n \\u003cp\\u003e8 (5.8)\\u003c/p\\u003e\\n \\u003cp\\u003e114 (82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 (10)\\u003c/p\\u003e\\n \\u003cp\\u003e3 (7.5)\\u003c/p\\u003e\\n \\u003cp\\u003e33 (82.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13 (13.1)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (5.1)\\u003c/p\\u003e\\n \\u003cp\\u003e81 (81.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.756\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOmentectomy\\u003c/p\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e122 (87.8)\\u003c/p\\u003e\\n \\u003cp\\u003e17 (12.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e36 (90)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (10)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e86(86.9)\\u003c/p\\u003e\\n \\u003cp\\u003e13 (13.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.778\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStage\\u003c/p\\u003e\\n \\u003cp\\u003e1a\\u003c/p\\u003e\\n \\u003cp\\u003e1b\\u003c/p\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e47 (38.8)\\u003c/p\\u003e\\n \\u003cp\\u003e25 (12,9)\\u003c/p\\u003e\\n \\u003cp\\u003e9 (6.5)\\u003c/p\\u003e\\n \\u003cp\\u003e58 (41.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (40)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (12.5)\\u003c/p\\u003e\\n \\u003cp\\u003e2 (5)\\u003c/p\\u003e\\n \\u003cp\\u003e17 (42.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e31 (31.3)\\u003c/p\\u003e\\n \\u003cp\\u003e20 (20.2)\\u003c/p\\u003e\\n \\u003cp\\u003e7 (7.1)\\u003c/p\\u003e\\n \\u003cp\\u003e41 (41.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.621\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAdjuvan treatment\\u003c/p\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003cp\\u003eKT\\u003c/p\\u003e\\n \\u003cp\\u003eRT\\u003c/p\\u003e\\n \\u003cp\\u003eKRT\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8 (5.8)\\u003c/p\\u003e\\n \\u003cp\\u003e19 (13.7)\\u003c/p\\u003e\\n \\u003cp\\u003e34 (24.5)\\u003c/p\\u003e\\n \\u003cp\\u003e78 (56.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2 (5)\\u003c/p\\u003e\\n \\u003cp\\u003e8 (20)\\u003c/p\\u003e\\n \\u003cp\\u003e9 (22.5)\\u003c/p\\u003e\\n \\u003cp\\u003e21 (52.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6 (6.1)\\u003c/p\\u003e\\n \\u003cp\\u003e11 (11.1)\\u003c/p\\u003e\\n \\u003cp\\u003e25 (25.3)\\u003c/p\\u003e\\n \\u003cp\\u003e57 (57.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.890\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eData are given as median or n (%). P\\u0026lt;0.05 accepted as statistically significant.\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eData in boldfont indicates statistically significant values.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eBMI: Body Mass Index, DM: diabetes mellitus; HT: hypertension, PLND: pelvic lymph node dissection, PPLND: pelvic and para-aortic lymph node dissection, KT: chemotherapy, KRT: chemoradiotherapy\\u003c/em\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThe most common histological type in the study group was serous EC with 38.8%. There was no difference between the groups in terms of histological types (p\\u0026thinsp;=\\u0026thinsp;0.147).More than half of myometrial invasion was detected in 35% of the patients in the adenomyosis group and in 45.5% of the patients in the non-adenomyosis group.No statistically significant difference was found between both groups(p\\u0026thinsp;=\\u0026thinsp;0.259). Similarly, no significant difference was found between adenomyotic and non-adenomyotic EC patients in the analysis of cervical stromal invasion, lympho-vascular space invasion, positive peritoneal fluid cytology, tumor size, omental metastasis and lymph node metastasis, which are poor prognostic indicators for EC (p\\u0026thinsp;=\\u0026thinsp;0.926, p\\u0026thinsp;=\\u0026thinsp;0.307, p\\u0026thinsp;=\\u0026thinsp;0.511, p\\u0026thinsp;=\\u0026thinsp;0.360, p\\u0026thinsp;=\\u0026thinsp;0.238 and p\\u0026thinsp;=\\u0026thinsp;0.717, respectively). The pathological findings of the patients are presented in Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003ePathological findings of patients Data are given as median or n (%). P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 accepted as statistically significant\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTotal Population\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;139)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAdenomyosis\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;40)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNon-adenomyosis\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;99)\\u003c/p\\u003e\\n \\u003cp\\u003eMedian or number (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHystological type\\u003c/p\\u003e\\n \\u003cp\\u003eSerous\\u003c/p\\u003e\\n \\u003cp\\u003eMucinous\\u003c/p\\u003e\\n \\u003cp\\u003eClear cell\\u003c/p\\u003e\\n \\u003cp\\u003eCarcinocarcoma\\u003c/p\\u003e\\n \\u003cp\\u003eUndifferentiated\\u003c/p\\u003e\\n \\u003cp\\u003eMixt type\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e54 (38.8)\\u003c/p\\u003e\\n \\u003cp\\u003e14 (10.1)\\u003c/p\\u003e\\n \\u003cp\\u003e17 (12.2)\\u003c/p\\u003e\\n \\u003cp\\u003e31 (22.3)\\u003c/p\\u003e\\n \\u003cp\\u003e16 (11.5)\\u003c/p\\u003e\\n \\u003cp\\u003e7 (5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (40)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (12.5)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (12.5)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (10)\\u003c/p\\u003e\\n \\u003cp\\u003e8 (20)\\u003c/p\\u003e\\n \\u003cp\\u003e2 (5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e38 (38.4)\\u003c/p\\u003e\\n \\u003cp\\u003e9 (9.1)\\u003c/p\\u003e\\n \\u003cp\\u003e12 (12.1)\\u003c/p\\u003e\\n \\u003cp\\u003e27 (27.3)\\u003c/p\\u003e\\n \\u003cp\\u003e8 (8.1)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (5.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.147\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMyometrial invasion\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1/2\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;1/2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e80 (57.6)\\u003c/p\\u003e\\n \\u003cp\\u003e59 (42.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26 (65)\\u003c/p\\u003e\\n \\u003cp\\u003e14 (35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e54 (54.5)\\u003c/p\\u003e\\n \\u003cp\\u003e45 (45.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.259\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCervical stromal invasion\\u003c/p\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32 (23)\\u003c/p\\u003e\\n \\u003cp\\u003e107 (77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 (22.5)\\u003c/p\\u003e\\n \\u003cp\\u003e31 (77.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23 (23.2)\\u003c/p\\u003e\\n \\u003cp\\u003e76 (76.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.926\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLymphovascular space invasion\\u003c/p\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e81 (58.3)\\u003c/p\\u003e\\n \\u003cp\\u003e58 (41.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26 (65)\\u003c/p\\u003e\\n \\u003cp\\u003e14 (35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e55 (55.6)\\u003c/p\\u003e\\n \\u003cp\\u003e44 (44.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.307\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTumor size, cm\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4 (0.4\\u0026ndash;15.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.75 (0.5\\u0026ndash;10.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4 (0.4\\u0026ndash;15.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.360\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePeritoneal fluid cytology\\u003c/p\\u003e\\n \\u003cp\\u003eNegative\\u003c/p\\u003e\\n \\u003cp\\u003ePositive\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e128 (92.1)\\u003c/p\\u003e\\n \\u003cp\\u003e11 (7.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e38 (95)\\u003c/p\\u003e\\n \\u003cp\\u003e2 (5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e90 (90.9)\\u003c/p\\u003e\\n \\u003cp\\u003e9 (9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.511\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOmental metastasis\\u003c/p\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16 (11.5)\\u003c/p\\u003e\\n \\u003cp\\u003e123 (88.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e7 (17.5)\\u003c/p\\u003e\\n \\u003cp\\u003e33 (82.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 (9.1)\\u003c/p\\u003e\\n \\u003cp\\u003e90 (90.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.238\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLymph node metastasis\\u003c/p\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003cp\\u003ePelvic\\u003c/p\\u003e\\n \\u003cp\\u003eParaaortic\\u003c/p\\u003e\\n \\u003cp\\u003ePelvic\\u0026thinsp;+\\u0026thinsp;paraaortic\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e104 (74.8)\\u003c/p\\u003e\\n \\u003cp\\u003e6 (4.3)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (3.6)\\u003c/p\\u003e\\n \\u003cp\\u003e24 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e33 (82.5)\\u003c/p\\u003e\\n \\u003cp\\u003e1 (2.5)\\u003c/p\\u003e\\n \\u003cp\\u003e1 (2.5)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (12.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e71 (71.7)\\u003c/p\\u003e\\n \\u003cp\\u003e5 (5.1)\\u003c/p\\u003e\\n \\u003cp\\u003e4 (4)\\u003c/p\\u003e\\n \\u003cp\\u003e19 (19.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.717\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData are given as median or n (%). P\\u0026lt;0.05 accepted as statistically significant\\u003c/p\\u003e\\n\\u003cp\\u003eMortality occurred in 56.83% (n\\u0026thinsp;=\\u0026thinsp;79) of the total population during follow-up in the study group. While 78.4% (n\\u0026thinsp;=\\u0026thinsp;62) of these patients were in the non-adenomyosis group, 21.6% (n\\u0026thinsp;=\\u0026thinsp;17) were in the adenomyosis group. The difference was not statistically significant (p\\u0026thinsp;=\\u0026thinsp;0.537). The mean overall survival time of the total study group during follow-up was 125.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.1 months while this period was 172\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.1 months in the adenomyosis group and 102\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.9 months in the non-adenomyosis group. There was a statistically significant difference between the groups in favor of EC patients with adenomyosis coexistence (p\\u0026thinsp;=\\u0026thinsp;0.021). The duration of recurrence in the total group was 137\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.8 months. Although this period was longer than the mean recurrence time of 175.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.4 months in the group with adenomyosis and 95.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.2 months in the non-adenomyotic group, it did not make a statistically significant difference (p\\u0026thinsp;=\\u0026thinsp;0.166). The recurrence and survival times of the patients are shown in Table 3. Progression-free survival by time in adenomyotic and non-adenomyotic groups in patients with EC is shown in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003ea, and overall survival is shown in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eb.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3\\u003c/strong\\u003e. Recurrence and survival time of patients\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"117%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.428571428571427%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.46938775510204%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal Population\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean\\u003cu\\u003e+\\u003c/u\\u003eSD or number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAdenomyosis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean\\u003cu\\u003e+\\u003c/u\\u003eSD or number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-adenomyosis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean\\u003cu\\u003e+\\u003c/u\\u003eSD or number (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.122448979591836%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.428571428571427%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eRecurence time, mounth\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.46938775510204%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e137.3 \\u003cu\\u003e+\\u003c/u\\u003e 13.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e175.2 \\u003cu\\u003e+\\u003c/u\\u003e 24,4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e95.1 \\u003cu\\u003e+\\u003c/u\\u003e 11.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.122448979591836%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.166\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.428571428571427%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eOverall survival time, mounth\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.46938775510204%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e125.1 \\u003cu\\u003e+\\u003c/u\\u003e 13.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e172.7 \\u003cu\\u003e+\\u003c/u\\u003e 24.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e102.2 \\u003cu\\u003e+\\u003c/u\\u003e 13.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.122448979591836%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.428571428571427%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDeath related to EC\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; Yes\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; No\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.46938775510204%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e79\\u003c/p\\u003e\\n \\u003cp\\u003e58 (73.4)\\u003c/p\\u003e\\n \\u003cp\\u003e21 (26.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003cp\\u003e14 (82.4)\\u003c/p\\u003e\\n \\u003cp\\u003e3 (17.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.489795918367346%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003cp\\u003e44 (71)\\u003c/p\\u003e\\n \\u003cp\\u003e18 (29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.122448979591836%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e0.537\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eData in boldfont indicates statistically significant values.\\u003c/p\\u003e\\n\\u003cp\\u003eData are given as mean \\u003cu\\u003e+\\u003c/u\\u003e SD or n (%). P \\u0026lt; 0.05 accepted as statistically significant.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eSeveral hypotheses have been proposed to explain the good prognosis in EC patients with adenomyosis. Increased levels of the antitumoral cytokines such as interferon-γ, tumor necrosis factor-α and interleukin 10 in adenomyosis tissue and decreased levels of oncogenic cytokines interleukin 1-beta, interleukin 8, epidermal growth factor and transforming growth factor create a protective effect. Another hypothesis is that adenomyosis blocks cancer invasion by mechanically contributing to the surrounding hypertrophic and hyperplastic myometrial stroma [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. On the contrary, some mechanisms may support the poor prognostic effect of adenomyosis. One of them is that the large contact area between the ectopic endometrium layer and the uterine muscle layer in adenomyosis can increase the depth of myometrial infiltration of EC. The other is that ectopic endometrium can increase the invasion of the lympho-vascular area by following the mechanism of spread through lymph and vessels [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. The literature also provides evidence for direct malignant transformation of adenomyosis. Endometrial Cancer caused by adenomyosis, which constitutes less than 1% of EC, originates from the epithelium of adenomyotic foci located between the muscle fibers of the uterine myometrium. A comparison of endometrial cancer arising in adenomyosis (EC-AIA) and endometrial cancer coexisting with adenomyosis (EC-A) concluded that EC-AIA is associated with poor survival [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe clinical significance of the association of adenomyosis and endometrial cancer has not been clearly established. Although the presence of adenomyosis has been shown to be associated with better overall survival, earlier stage and lower FIGO grade in patients with endometrioid type EC, there is still uncertainty about the prognosis for patients with non-endometrioid endometrial cancer. To our knowledge, there are a few studies in the literature on the relationship between non-endometrioid EC and adenomyosis [\\u003cspan additionalcitationids=\\\"CR12 CR13\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Due to the limitations of studies in the literature, in this study we tried to determine whether the presence of adenomyosis has a positive or negative prognostic effect on OS and DFS in patients with non-endometrioid EC.\\u003c/p\\u003e \\u003cp\\u003eAccording to Raffone et al.'s analysis of eight retrospective cohort studies evaluating 5573 EC patients to better understand the prevalence, histological association and relationship between endometrial carcinoma and adenomyosis, the pooled adenomyosis prevalence was found to be 22.6%.This result revealed that the prevalence of adenomyosis in EC patients was not different from that reported for other gynecological conditions. Also, EC patients with adenomyosis have a significantly reduced risk for adverse histologic prognostic factors of EC compared to EC patients without adenomyosis. Such findings may explain the proposed better EC prognosis in patients with adenomyosis [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn a recent meta-analysis by An et al., based on 14 retrospective observational studies including 1308 patients withEC with adenomyosis and 3734 patients with ECwithout adenomyosis, a positive increase in OS was observed in patients with adenomyosis, but no difference in DFS was observed between the two groups. It was also observed that patients with adenomyosis were younger, had less deep MI, less LVSI positivity, and more grade 1 and FIGO I-II stages. It has been reported that there is no significant difference in terms of histologic type and lymph node metastasis [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. In our study, no difference was found in terms of prognostic factors.\\u003c/p\\u003e \\u003cp\\u003eThe results of another meta-analysis showed that it significantly increased OS in EC patients with concomitant adenomyosis, but unlike most studies, there was no difference in DFS. However, some of the studies comprising this meta-analysis included only EC patients with endometrioid histologic type. Since endometrioid histologic type is the group with the best prognosis in EC patients, the results of the current meta-analysis may have been affected by this patient selection [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eMatsuo et al., in their study including stage 1\\u0026ndash;4 EC patients, stated that the adenomyosis group was at an earlier stage and the probability of myometrial invasion and cervical invasion was lower. Furthermore, significantly better DFS and OS were reported in the EC group with adenomyosis in this study. When both disease-free survival and overall survival time between the endometrioid and non-endometrioid groups were evaluated, it was found that both were better in the endometrioid group. An independent effect of adenomyosis could not be demonstrated in multivariate analysis. No subgroup analysis was performed in terms of survival between patients with and without adenomyosis in the non-endometrioid group [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. In our study, the OS in the adenomyosis group was 172\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.1 months, which was significantly better than the mean OS of the non-adenomyotic EC group, which was 102\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.9 months. However, we did not detect any difference in DFS between the adenomyotic and non-adenomyotic groups in our study.\\u003c/p\\u003e \\u003cp\\u003eSanci et al. evaluated the effect of adenomyosis on overall survival and prognostic histopathological factors in 400 EC patients. The study found no difference between the 2 groups in terms of disease-free survival and death from cancer. However, multivariate analysis revealed an independent positive effect of adenomyosis on overall survival [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Since the number of non-endometrioid patients in the study was only 25, adenomyosis and non-adenomyosis subgroup analysis could not be performed in this group.\\u003c/p\\u003e \\u003cp\\u003eIn the study of \\u0026Ccedil;elik et al., both endometrioid and non-endometrioid EC types were included. Sub-analysis was performed to show the impact of different histological types on the results and a significant difference in the reduction of mortality was found in endometrioid type EC. There was no difference in disease-free survival and disease-related death between non-endometrioid type EC with and without adenomyosis. Disease-specific survival was significantly longer in patients with adenomyosis in the entire patient group, but progression-free survival was not affected by the presence of adenomyosis. These patients with coexistent adenomyosis and EC had better clinicopathological features and less advanced tumors. However, in multivariate analysis, adenomyosis was not found to be an independent prognostic factor for EC [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. In our study, there was no significant difference between the adenomyosis group and the non-adenomyosis group in terms of these negative prognostic indicators.\\u003c/p\\u003e \\u003cp\\u003eOne of the strengths of our study is that it includes a larger number of patients compared to studies in the literature where the number of patients with non-endometrioid endometrial cancer is limited. A significant contribution has been made to the literature on this subject, which contains contradictory evidence. All patients were operated on at a single center and pathological samples were evaluated by experienced gynecological pathologists. The retrospective design can be considered a limitation of our study.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eIn conclusion, this study showed that the presence of adenomyosis was only significantly associated with higher overall survival in non-endometrioid EC. This result revealed in our study highlights that the presence of adenomyosis should be considered as a good prognostic factor in all EC types, including non-endometrioid endometrial cancer.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor\\u0026rsquo;s Information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLevent Ozgen\\u003csup\\u003e1\\u003c/sup\\u003e, Yakup Yalcin\\u003csup\\u003e1\\u003c/sup\\u003e, Merve Abay\\u003csup\\u003e1\\u003c/sup\\u003e, Kemal Ozerkan\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor\\u0026rsquo;s and affiliations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLevent Ozgen\\u003csup\\u003e1\\u003c/sup\\u003e, Yakup Yalcin\\u003csup\\u003e1\\u003c/sup\\u003e, Merve Abay\\u003csup\\u003e1\\u003c/sup\\u003e, Kemal Ozerkan\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003csup\\u003e1\\u003c/sup\\u003eDivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Bursa Uludag, Bursa, Turkey\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eContributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLO., project development, data collection, manuscript writing,\\u0026nbsp;supervision.\\u0026nbsp;YY., project development, manuscript writing,\\u0026nbsp;supervision.\\u0026nbsp;MA., data collection,\\u0026nbsp;ınvestigation.\\u0026nbsp;KO.,manuscript writing,\\u0026nbsp;supervision.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCorresponding Author:\\u003c/strong\\u003e Yakup Yalcin, dryakupyalcin@gmail.com\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics declarations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthics approval and consent to participate\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University UludagcMedicine Faculty\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e(Date: 28/02/2022 Decision No: 2011-KAEK-26/118).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eInformed consent was obtained from all individual participants included in the study.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWang J, Wang Q, Wang W, Yang J, Xia J, Wei Y. Endometrioid adenocarcinoma arising in adenomyosis in a patient with pelvic organ prolapse\\u0026mdash;case report. BMC Womens Health. 2023;23(1):150. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12905-023-02310-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12905-023-02310-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOaknin A, Bosse TJ, Creutzberg CL, Giornelli G, Harter P. Endometrial cancer: ESMO Clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(9):860\\u0026ndash;77. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.annonc.2022.05.009\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.annonc.2022.05.009\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKo EM, Walter P, Clark L, Jackson A, Franasiak J, Bolac C, et al. 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Arch Gynecol Obstet. 2021;303(1):47\\u0026ndash;53. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00404-020-05840-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00404-020-05840-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJohnatty SE, Stewart CJ, Smith D, NguyenA, O\\u0026rsquo;Dwyer J, O\\u0026rsquo;MaraTA, et al. Co-existence of leiomyomas, adenomyosis and endometriosis in women with endometrial cancer. 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Arch Gynecol Obstet. 2017;295:1459\\u0026ndash;68. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00404-017-4375-z\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00404-017-4375-z\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHermens M, van Altena AM, van de VelthuisI DC, Bulten J, Van Vliet HA, et al. Endometrial cancer incidence in endometriosis and adenomyosis. Cancers. 2021;13(18):4592. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/cancers13184592\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/cancers13184592\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRaimondo D, Raffone A, Travaglino A, Maletta M, Casadio P, Ambrosio M, et al. 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Rev Assoc Med Bras. 2023;69:e20221720. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1590/1806-9282.20221720\\u003c/span\\u003e\\u003cspan address=\\\"10.1590/1806-9282.20221720\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSanci M, Erkilin\\u0026ccedil; S, Taylan E, G\\u0026uuml;lseren V, Erkilin\\u0026ccedil; G, Karadeniz T, et al. The effect of adenomyosis in myometrial invasion and overall survival in endometrial cancer. Int J Gynecol Cancer. 2018;28(1):145\\u0026ndash;51. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/IGC.0000000000001137corr1\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/IGC.0000000000001137corr1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCelik E, Goksever Celik H, Sozen H, Onder S, Tosun OA, Topuz S, et al. The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study. J Obstet Gynaecol Res. 2022;42(1):158\\u0026ndash;65. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/01443615.2021.1980508\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/01443615.2021.1980508\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAn M, Duan H, Zhang Y. Prognostic significance of co-existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: a meta‐analysis. J Obstet Gynaecol Res. 2020;46(9):1851\\u0026ndash;63. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/jog.14371\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/jog.14371\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"adenomyosis, disease free survival, non-endometrioid endometrial cancer, overall survival\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4803752/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4803752/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eThe impact of the presence of adenomyosis on survival in patients with non-endometrioid endometrial cancer (EC) remains unclear.The aim of this study is to compare the effect of the presence or absence of histologically proven adenomyosis on the survival of patients with non-endometrioid EC.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eWe identified all patients who were consecutively diagnosed with non-endometrioid EC and underwent surgery in a single center between May 1998 and March 2023. Patients with insufficient clinical or surgical data were excluded from the study. A total of 139 non-endometrioid EC patients in the study were divided into two groups as with and without adenomyosis. Demographic characteristics and clinical findings such as age, BMI, menopausal status and pathologic variables such as presence of adenomyosis, tumor grade, depth of myometrial invasion, lymphovascular space involvement, lymph node status, and distant spread were obtained hospital records.Kaplan Meier analysis was performed for survival analysis. Overall (OS), and disease-free survival (DFS) were calculated.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eA total of 139 patients, 40 (28.7%) in the adenomyosis group and 99 (71.3%) in the non-adenomyosis group, were included in the study and their data were recorded.There was no significant difference between patients with non-endometrioid type EC with and without adenomyosis in terms of patient demographic characteristics and pathological variables (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05).When the patients in the adenomyosis and non-adenomyosis groups were compared, there was no statistically significance regarding recurrence time (175.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.4 months vs 95.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.2 months, p\\u0026thinsp;=\\u0026thinsp;0.166). However, OS was found to be statistically significantly higher in patients with adenomyosis than in those without adenomyosis (172\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;24.1 months vs 102\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.9 months; p\\u0026thinsp;=\\u0026thinsp;0.02).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eThe presence of adenomyosis in non-endometrioid type endometrial cancer was not associated with pathological variables such as myometrial invasion, tumor diameter and lympho-vascular space involvement. Although DFS and cancer-related death rates were similar, OS was significantly higher in the presence of adenomyosis.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Impact of Uterine Adenomyosis on Survival Outcome of Patients with Non-Endometrioid Endometrial Cancer\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-08-28 02:05:52\",\"doi\":\"10.21203/rs.3.rs-4803752/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-08-01T19:14:22+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-08-01T10:38:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-07-26T09:30:47+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cancer\",\"date\":\"2024-07-25T18:32:10+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"1f013b21-1094-4ec2-9eae-2f8e3e4ff85c\",\"owner\":[],\"postedDate\":\"August 28th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-10-20T16:07:39+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4803752\",\"link\":\"https://doi.org/10.1186/s12885-025-14815-4\",\"journal\":{\"identity\":\"bmc-cancer\",\"isVorOnly\":false,\"title\":\"BMC Cancer\"},\"publishedOn\":\"2025-10-14 15:58:18\",\"publishedOnDateReadable\":\"October 14th, 2025\"},\"versionCreatedAt\":\"2024-08-28 02:05:52\",\"video\":\"\",\"vorDoi\":\"10.1186/s12885-025-14815-4\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12885-025-14815-4\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4803752\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4803752\",\"identity\":\"rs-4803752\",\"version\":[\"v1\"]},\"buildId\":\"WvIrzKhiLBfengagbw6Ux\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC0","license_restricted":false}