Impact of uterine adenomyosis on survival outcome of patients with non-endometrioid endometrial cancer

TL;DR

This study finds that uterine adenomyosis is linked to better overall survival in non-endometrioid endometrial cancer patients.

Contribution

The study is the first to show a survival benefit of adenomyosis in non-endometrioid endometrial cancer patients.

Findings

Patients with adenomyosis had significantly higher overall survival compared to those without.

Adenomyosis was not associated with worse pathological features like myometrial invasion or tumor size.

Disease-free survival and cancer-related death rates were similar between the two groups.

Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s12885-025-14815-4.

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