Impact of adenomyosis on the prognosis of patients with endometrial cancer.
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ABSTRACT: Background
Despite the high prevalence of adenomyosis in hysterectomy specimens of endometrial carcinoma (EC) patients, the relationship between adenomyosis and EC prognosis appears unclear.Objective
To assess the prognostic value of coexistent adenomyosis in patients with EC.Methods
A systematic review and meta-analysis was performed by searching six electronic databases for studies reporting data on prognosis of EC patients with and without coexistent adenomyosis. Studies with patient selection based on prognostic factors were excluded. Pooled univariate hazard ratio (HR) analyses for overall survival (OS) and disease-free survival (DRF) were performed, using EC patients without adenomyosis as a control group. For DFS, pooled multivariate HR analysis was also evaluable.Results
Three studies of 2505 EC patients (553 with and 1952 without adenomyosis) were included. Compared with EC patients without adenomyosis, EC patients with coexistent adenomyosis showed a pooled HR of 0.533 (CI 95%, 0.329-0.864) for OS at univariate analysis; 0.536 (CI 95%, 0.334-0.859) for DFS at univariate analysis; and 0.875 (CI 95%, 0.331-2.315) for DFS at multivariate analysis.Conclusion
In EC patients with coexistent adenomyosis, the risk of death is halved compared with EC patients without adenomyosis. However, the independence of this association needs to be verified in future studies.
SUBMITTER: Raimondo D
PROVIDER: S-EPMC9292168 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeWhile adenomyosis is one of the most common benign histologic findings in hysterectomy specimens of endometrial cancer, demographics of endometrial cancer arising in adenomyosis (EC-AIA) has not been well elucidated. The aim of this study is to evaluate histopathological findings and disease-free survival (DFS) of EC-AIA in comparison to endometrial cancer coexisting with adenomyosis (EC-A).MethodsEC-AIA cases were identified via a systematic literature search (n = 46). EC-A cases were identified from a historical cohort that underwent hysterectomy-based surgical staging in two institutions (n = 350). Statistical comparisons of the two groups were based on univariate and multivariate analyses.ResultsThe EC-AIA group was significantly older than the EC-A group (58.9 versus 53.8, p = 0.002). As to tumor characteristics, 63.6% of EC-AIA cases reported tumor within the myometrium without endometrial extension. The EC-AIA group was significantly associated with more non-endometrioid histology (23.9 versus 14.8%; p = 0.002) and deep myometrial tumor invasion (51.6 versus 19.4%; p < 0.001) than EC-A. Tumor grade, stage, and nodal metastasis risk were similar (all, p > 0.05). In a univariate analysis, the EC-AIA group had a significantly decreased DFS compared to EC-A (5-year rates, 72.2 versus 85.5%, p = 0.001). After controlling for age, histology, tumor grade, and stage, EC-AIA remained an independent prognostic factor associated with decreased DFS compared to EC-A (adjusted-hazard ratio 2.87, 95% confidence interval 1.44-5.70, p = 0.031).ConclusionOur study demonstrated that EC-AIA has distinct tumor characteristics and a poorer survival outcome compared to EC-A. This suggests a benefit of recognition of this unique entity as an aggressive variant of endometrial cancer.
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Project description:OBJECTIVE:To examine the association of coexistence of adenomyosis and endometrial carcinoma on tumor characteristics and survival outcome of patients. METHODS:Clinical and pathological data were retrospectively reviewed from 1584 patients who underwent surgical treatment of endometrial carcinoma. Statistical analyses were performed to evaluate associations of the presence or absence of adenomyosis with demographics, clinical parameters, histopathological factors, and survival outcomes. RESULTS:Adenomyosis was found in 150/1584 patients, and was significantly associated with premenopausal status (46% vs. 35.15%, P = 0.008), younger age (60.67% vs. 41.92% < 55 years old, P < 0.001), lower positive p53 expression (53.36% vs. 63.32%, P = 0.034), earlier disease stage (I-II) (92.67% vs. 85.56%, P = 0.016), lower grade of the tumors (1-2) (91.33% vs. 84.52%, P = 0.025), lower likelihood of outer-half myometrial invasion (10% vs. 22.25%, P < 0.001), and absence of pelvic lymph node metastasis (97.04% vs. 92.09%, P = 0.037). The presence of adenomyosis was also associated with better survival outcomes, with a higher 5-year survival rate (92.1% vs. 84.1%, P = 0.045). In multivariate analysis, age, BMI, stage/grade of tumors, and myometrial invasion were independent prognostic factors associated with survival outcomes. CONCLUSION:The presence of adenomyosis was associated with less aggressive behavior of endometrial cancer and is a protective factor associated with better outcomes of patients.
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Project description:BackgroundEndometrial cancer arising in adenomyosis (EC-AIA) is a rare entity of endometrial cancer, and its clinical significance has not been well studied. This study aimed to examine the tumor characteristics and survival outcomes of EC-AIA.MethodsAn exploratory analysis was performed to compare EC-AIA and historical control cases. For this study, EC-AIA cases were identified via a systematic literature search using PubMed/MEDLINE with entry keywords "endometrial cancer OR uterine cancer" AND "adenomyosis" (n = 46). The control group comprised consecutive non-EC-AIA cases from four institutions that had hysterectomy-based surgical staging (n = 1294). Patient demographics, pathology results, and survival outcomes were evaluated between the two groups.ResultsThe EC-AIA group was significantly older than the control group (58.9 vs. 55.3 years; P = 0.032). In terms of tumor characteristics, 56.5% of the EC-AIA cases showed tumor within the myometrium without endometrial extension, and the EC-AIA group was significantly more likely to have tumors with more than 50% myometrial invasion (51.6 vs. 26.6%; P = 0.002) and serous/clear cell histology (22.2 vs. 8.2%, P = 0.002) while less likely to express estrogen receptor (14.3 vs. 84.6%; P < 0.001). Grade and stage distributions were similar (P > 0.05). In the univariate analysis, the EC-AIA group had a significantly poorer disease-free survival than the control group (5-year rate: 71.4 vs. 80.6%; P = 0.014). In the multivariate analysis, with control for age, ethnicity, histology, grade, and stage, EA-CIC remained an independent prognostic factor for decreased disease-free survival (adjusted hazard ratio, 3.07; 95% confidence interval 1.55-6.08; P = 0.001).ConclusionsThe study suggested that endometrial cancer arising in adenomyosis may be an aggressive variant of endometrial cancer.
| S-EPMC7521605 | biostudies-literature