Background The prognostic significance of adenomyosis in endometrial cancer (EC) remains controversial. Although several studies have suggested an association between adenomyosis and favorable tumor characteristics or improved survival outcomes, it remains unclear whether this relationship persists after adjustment for established clinicopathologic prognostic factors. Aim To investigate the impact of coexisting adenomyosis on clinicopathologic characteristics and survival outcomes in patients with endometrioid-type endometrial cancer. Methods This retrospective cohort study included 527 consecutive patients with histologically confirmed endometrioid-type endometrial cancer who underwent primary surgical treatment between January 2010 and May 2025 at a tertiary gynecologic oncology center. Patients were categorized according to the presence or absence of adenomyosis identified in hysterectomy specimens. Clinicopathologic characteristics were compared between groups. Disease-free survival (DFS) and overall survival (OS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses. Results Adenomyosis was identified in 154 patients (29.2%). No significant differences were observed between patients with and without adenomyosis regarding age, tumor grade, FIGO stage, myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastasis, or adjuvant treatment (all p > 0.05). Kaplan–Meier analysis demonstrated no significant differences in either DFS or OS according to adenomyosis status (log-rank p = 0.626 and p = 0.697, respectively). In multivariable analysis, LVSI remained the only independent predictor of poorer DFS (HR 2.15, 95% CI 1.02–4.53, p = 0.044), whereas older age (HR 1.08, 95% CI 1.06–1.12, p < 0.001), grade 3 histology (HR 2.11, 95% CI 1.26–3.54, p = 0.005), advanced FIGO stage (HR 1.92, 95% CI 1.18–2.93, p = 0.003), and positive peritoneal cytology (HR 4.47, 95% CI 1.20–16.64, p = 0.026) were independently associated with poorer OS. Adenomyosis was not identified as an independent prognostic factor for either DFS or OS. Conclusion In this cohort of patients with endometrioid-type endometrial cancer, coexisting adenomyosis was not independently associated with distinct clinicopathologic features, disease-free survival, or overall survival. Established clinicopathologic factors remained the primary determinants of oncologic outcomes.

Adenomyosis is not an independent prognostic factor in endometrioid-type endometrial cancer

期刊论文
发表日期：

2026年7月3日

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Yakup Yalcin,
Kemal Ozerkan

摘要

Background

The prognostic significance of adenomyosis in endometrial cancer (EC) remains controversial. Although several studies have suggested an association between adenomyosis and favorable tumor characteristics or improved survival outcomes, it remains unclear whether this relationship persists after adjustment for established clinicopathologic prognostic factors.

Aim

To investigate the impact of coexisting adenomyosis on clinicopathologic characteristics and survival outcomes in patients with endometrioid-type endometrial cancer.

Methods

This retrospective cohort study included 527 consecutive patients with histologically confirmed endometrioid-type endometrial cancer who underwent primary surgical treatment between January 2010 and May 2025 at a tertiary gynecologic oncology center. Patients were categorized according to the presence or absence of adenomyosis identified in hysterectomy specimens. Clinicopathologic characteristics were compared between groups. Disease-free survival (DFS) and overall survival (OS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses.

Results

Adenomyosis was identified in 154 patients (29.2%). No significant differences were observed between patients with and without adenomyosis regarding age, tumor grade, FIGO stage, myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastasis, or adjuvant treatment (all p > 0.05). Kaplan–Meier analysis demonstrated no significant differences in either DFS or OS according to adenomyosis status (log-rank p = 0.626 and p = 0.697, respectively). In multivariable analysis, LVSI remained the only independent predictor of poorer DFS (HR 2.15, 95% CI 1.02–4.53, p = 0.044), whereas older age (HR 1.08, 95% CI 1.06–1.12, p < 0.001), grade 3 histology (HR 2.11, 95% CI 1.26–3.54, p = 0.005), advanced FIGO stage (HR 1.92, 95% CI 1.18–2.93, p = 0.003), and positive peritoneal cytology (HR 4.47, 95% CI 1.20–16.64, p = 0.026) were independently associated with poorer OS. Adenomyosis was not identified as an independent prognostic factor for either DFS or OS.

Conclusion

In this cohort of patients with endometrioid-type endometrial cancer, coexisting adenomyosis was not independently associated with distinct clinicopathologic features, disease-free survival, or overall survival. Established clinicopathologic factors remained the primary determinants of oncologic outcomes.