Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis

Abstract

A better endometrial cancer (EC) prognosis in patients with coexistent adenomyosis has been reported. Unfortunately, it is still unclear if this better prognosis is related to a more favorable clinical profile of adenomyosis patients. We aimed to evaluate differences in the clinical profiles of EC patients with and without adenomyosis. A systematic review and meta-analysis was performed by searching seven electronics databases for all studies that allowed extraction of data about clinical characteristics in EC patients with and without adenomyosis. Clinical characteristics assessed were: age, Body Mass Index (BMI), premenopausal status, and nulliparity. Mean difference in mean ± standard deviation (SD) or odds ratio (OR) for clinical characteristics between EC patients with and without adenomyosis were calculated for each included study and as a pooled estimate, and graphically reported on forest plots with a 95% confidence interval (CI). The Z test was used for assessing the overall effect by considering a p value < 0.05 as significant. Overall, eight studies with 5681 patients were included in the qualitative analysis, and seven studies with 4366 patients in the quantitative analysis. Pooled mean difference in mean ± SD between EC women with and without adenomyosis was −1.19 (95% CI: −3.18 to 0.80; p = 0.24) for age, and 0.23 (95% CI: −0.62 to 1.07; p = 0.60) for BMI. When compared to EC women without adenomyosis, EC women with adenomyosis showed a pooled OR of 1.53 (95% CI: 0.92 to 2.54; p = 0.10) for premenopausal status, and of 0.60 (95% CI: 0.41 to 0.87; p = 0.007) for nulliparity. In conclusion, there are not significant differences in clinical characteristics between EC patients with and without adenomyosis, with the exception for nulliparity. Clinical features seem to not underlie the better EC prognosis of patients with adenomyosis compared to patients without adenomyosis.

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

“…On the contrary, the neoplastic potential in adenomyosis is poorly understood, and has been mainly described in association with EC. The coincidence between these two diseases can be an effect of potential common risk factors, which may lead to hyper-estrogenic status (history of diabetes, hypertension, high BMI, and tamoxifen intake, but not nulliparity [ 58 ]) or by shared pathogenetic mechanisms, including genetic mutation and inflammatory factors that induce angiogenesis and cell proliferation, which promote carcinogenesis. According to the presented data, adenomyosis seems to be a favorable prognostic oncological factor when it occurs with EC, but the finding appears to be contradictory.…”

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

Molecular Signature of Endometrial Cancer with Coexistent Adenomyosis: A Multicentric Exploratory Analysis

“…In particular, differences in the prevalence of pathological, clinical and/or molecular prognostic factors between women with and without coexistent adenomyosis have been supposed. In detail, while clinical factors (with the exception for nulliparity) have shown no significant differences between endometrial cancer patients with and without adenomyosis, conventional pathological prognostic factors have been shown to be less frequently unfavorable in endometrial cancer patients with adenomyosis compared to endometrial cancer patients without adenomyosis [8,14]. However, to our knowledge, data about molecular prognostic factors (i.e., molecular groups) in endometrial cancer patients with coexistent adenomyosis have never been reported; thus, the impact of the molecular signature on the reported favorable prognosis of endometrial cancer patients with coexistent adenomyosis is unknown.…”

“…Endometrial cancer is the most frequent gynecological neoplasm in Western countries [1][2][3][4][5][6][7][8]. The risk stratification of endometrial cancer patients had been mainly based on post-surgical pathological prognostic factors prior to the introduction of the Cancer Genome Atlas (TCGA) Research Network molecular classification [9] and the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) [1,2,4,10,11].…”

Effect of adenomyosis on prognosis of patients with endometrial cancer

“…However, in other studies, adenomyosis with EC has been linked to early-stage malignancy and extended surveillance 7 . Furthermore, subsequent investigations have demonstrated that adenomyosis does not negatively affect the prognosis and questionnaires of EC patients 8,9 . It is therefore still unclear whether EC and adenomyosis are related.…”