Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer

Background Prognostic value of accompanying adenomyosis in endometrial cancer is the subject of interest due to their common etiology and co-occurrence frequency. However, it is still unclear whether adenomyosis has a role in the prognosis of endometrial cancer. Aims The aim of this study was to determine the effects of adenomyosis on the prognosis of patients with endometrial cancer.

In this study, medical records of 552 patients with endometrioid endometrial cancer who underwent surgery between 2007 and 2017 were retrospectively reviewed. The patients were divided into two groups based on the presence or absence of adenomyosis, and these two groups were compared in terms of the clinicopathological factors and survival outcomes of patients.

Of these patients, 103 (18.7%) had adenomyosis, and the remaining 449 (81.3%) did not. The endometrial cancer patients with adenomyosis exhibited earlier stages (p < 0.001), lower tumor grades (p < 0.001), tumor sizes ≤ 2 cm (p = 0.002), myometrial invasion < 50% (p < 0.001), and negative lymphovascular space invasion (p < 0.001). The 5-year overall survival rate was comparable between the adenomyosis and non-adenomyosis groups (95 vs. 89.1%, respectively; p = 0.085). The presence of adenomyosis was significantly associated with a higher 5-year disease-free survival rate (95.1 vs. 87.9%; p = 0.047), but adenomyosis did not remain as a prognostic factor in multivariate analysis.

The results of our study showed that the endometrioid endometrial cancer patients with adenomyosis are significantly associated with smaller tumor sizes, less myometrial invasion, lower tumor grades, less lymphovascular space invasion, and earlier FIGO stages. Nevertheless, adenomyosis was not found to be an independent prognostic factor for endometrioid endometrial cancer. Access this article We’re sorry, something doesn't seem to be working properly. Please try refreshing the page. If that doesn't work, please contact support so we can address the problem. Similar content being viewed by others

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108 Seebacher V, Schmid M, Polterauer S et al (2009) The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 9:460 Colombo N, Creutzberg C, Amant F et al (2015) ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO–ESGO–ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Radiother Oncol 117:559–581 Bergeron C, Amant F, Ferenczy A (2006) Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:511–521 García-Solares J, Donnez J, Donnez O, Dolmans MM (2018) Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertil Steril 109:371–379 Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB (2001) Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 16:2418–2421 Nishida M (1991) Relationship between the onset of dysmenorrhea and histologic findings in adenomyosis. Am J Obstet Gynecol 165:229–231 Benson RC, Sneeden VD (1958) Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol 76:1044–1061 Kucera E, Hejda V, Dankovcik RVP et al (2011) Malignant changes in adenomyosis in patients with endometrioid adenocarcinoma. Eur J Gynaecol Oncol 32:182–184 Gizzo S, Patrelli TS, Dall’asta A et al (2016) Coexistence of adenomyosis and endometrioid endometrial cancer: role in surgical guidance and prognosis estimation. Oncol Lett 11:1213–1219 Matsuo K, Cahoon SS, Gualtieri M, Scannell CA, Jung CE, Takano T, Paulson RJ, Muderspach LI, Roman LD (2014) Significance of adenomyosis on tumor progression and survival outcome of endometrial cancer. Ann Surg Oncol 21:4246–4255 LINDA H, JOHANNA R, ZEDER-GÖSS C et al (2017) Coexistence of adenomyosis uteri and endometrial cancer is associated with an improved prognosis compared with endometrial cancer onlye. Oncol Lett 14:3302–3308 Taneichi A, Fujiwara H, Takahashi Y, Takei Y, Machida S, Saga Y, Takahashi S, Suzuki M (2014) Influences of uterine adenomyosis on muscle invasion and prognosis of endometrioid adenocarcinoma. Int J Gynecol Cancer 24:1429–1433 Musa F, Frey MK, Im HB et al (2012) Does the presence of adenomyosis and lymphovascular space invasion affect lymph node status in patients with endometrioid adenocarcinoma of the endometrium? Am J Obstet Gynecol 207(417):e1–417.e6 Nomura H, Aoki D, Suzuki N, Susumu N, Suzuki A, Tamada Y, Kataoka F, Higashiguchi A, Ezawa S, Nozawa S (2006) Analysis of clinicopathologic factors predicting para-aortic lymph node metastasis in endometrial cancer. Int J Gynecol Cancer 16:799–804 Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182:1506–1519 Shepherd JH (1989) Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 96:889–892 Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, Pearlman A, Maiman MA, Bell JG, Gynecologic Oncology Group (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A gynecologic oncology group study. Gynecol Oncol 92:744–751 Siegler AM, Camilien L (1994) Adenomyosis. J Reprod Med 39:841–853 Kairi-Vassilatou E, Kontogianni K, Salamalekis M, Sykiotis K, Kondi-Pafitis A (2004) A clinicopathological study of the relationship between adenomyosis and other hormone-dependent uterine lesions. Eur J Gynaecol Oncol 25:222–224 Ota H, Igarashi S, Hatazawa J, Tanaka T (1998) Is adenomyosis an immune disease? Hum Reprod Update 4:360–367 Sahin AA, Silva EG, Landon G, Ordonez NG, Gershenson DM (1989) Endometrial tissue in myometrial vessels not associated with menstruation. Int J Gynecol Pathol 8:139–146 Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4:312–322 Erkilinç S, Taylan E, Varol G et al (2018) The effect of adenomyosis in myometrial invasion and overall survival in endometrial cancer. Int J Gynecol Cancer 28:145–151 Berretta R, Patrelli TS, Migliavacca C, Rolla M, Franchi L, Monica M, Modena AB, Gizzo S (2014) Assessment of tumor size as a useful marker for the surgical staging of endometrial cancer. Oncol Rep 31:2407–2412 Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041 Ayik Aydin H, Toptas T, Bozkurt S et al (2017) Impact of coexistent adenomyosis on outcomes of patents with endometrioid endometrial cancer: a propensity score-matched analysis. Tumori 104:60–65 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval Subjects have given their written informed consent. The study protocol has been approved by the research institute’s committee on human research. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Aslan, K., Sarı, M.E., Yalçın, H.R. et al. Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer. Ir J Med Sci 189, 835–842 (2020). https://doi.org/10.1007/s11845-020-02172-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11845-020-02172-z