Tumor Characteristics and Survival Outcome of Endometrial Cancer Arising in Adenomyosis: An Exploratory Analysis

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2015 Nov 7

PMID 26542589

Citations 20

Authors

Koji Matsuo

Aida Moeini

Hiroko Machida

Christopher A Scannell

Jennifer K Casabar

Mamoru Kakuda

Sosuke Adachi

Jocelyn Garcia-Sayre

Yutaka Ueda

Lynda D Roman

Affiliations

Soon will be listed here.

Abstract

Background: Endometrial 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.

Methods: An 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.

Results: The 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).

Conclusions: The study suggested that endometrial cancer arising in adenomyosis may be an aggressive variant of endometrial cancer.

Citing Articles

The Impact of Adenomyosis on Pregnancy.

Tsikouras P, Kritsotaki N, Nikolettos K, Kotanidou S, Oikonomou E, Bothou A Biomedicines. 2024; 12(8).

PMID: 39200389 PMC: 11351718. DOI: 10.3390/biomedicines12081925.

Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? A systematic review and meta-analysis.

Sun Y, Lin S, Wu W, Nie F, Liu Y, Wen J Int J Surg. 2024; 110(5):3072-3080.

PMID: 38445439 PMC: 11093450. DOI: 10.1097/JS9.0000000000001234.

Adenomyosis and Its Possible Malignancy: A Review of the Literature.

Moraru L, Mitranovici M, Chiorean D, Moraru R, Caravia L, Tiron A Diagnostics (Basel). 2023; 13(11).

PMID: 37296736 PMC: 10252751. DOI: 10.3390/diagnostics13111883.

Endometrioid adenocarcinoma arising in adenomyosis in a patient with pelvic organ prolapse-case report.

Wang J, Wang Q, Wang W, Yang J, Xia J, Wei Y BMC Womens Health. 2023; 23(1):150.

PMID: 36997927 PMC: 10064737. DOI: 10.1186/s12905-023-02310-6.

Endometrial Cancer Arising in Adenomyosis (EC-AIA): A Systematic Review.

Raffone A, Raimondo D, Maletta M, Travaglino A, Renzulli F, Neola D Cancers (Basel). 2023; 15(4).

PMID: 36831484 PMC: 9953860. DOI: 10.3390/cancers15041142.

References

Couto D, Mota F, Silva T, de Oliveira C . Adenocarcinoma arising in adenomyosis: report of an unusual case. Acta Obstet Gynecol Scand. 2004; 83(4):406-8. DOI: 10.1111/j.0001-6349.2004.00025b.x. View

Sasaki T, Sugiyama T, Nanjo H, Hoshi N, Murakami M, Sugita A . Endometrioid adenocarcinoma arising from adenomyosis: report and immunohistochemical analysis of an unusual case. Pathol Int. 2001; 51(4):308-13. DOI: 10.1046/j.1440-1827.2001.01200.x. View

COLMAN H, ROSENTHAL A . Carcinoma developing in areas of adenomyosis. Obstet Gynecol. 1959; 14:342-8. View

Shirai T, Yoshida M, Takahashi M, Shiromizu K, Nishida K, Sano Y . Endometrial cytology in early diagnosis of adenocarcinoma arising from adenomyosis uteri. Acta Cytol. 2002; 46(3):612-4. View

Takai N, Akizuki S, Nasu K, Etoh Y, Miyakawa I . Endometrioid adenocarcinoma arising from adenomyosis. Gynecol Obstet Invest. 1999; 48(2):141-4. DOI: 10.1159/000010139. View

Bats A, Zafrani Y, Pautier P, Duvillard P, Morice P . Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report and review of the literature. Fertil Steril. 2007; 90(4):1197.e13-6. DOI: 10.1016/j.fertnstert.2007.08.080. View

Koshiyama M, Suzuki A, Ozawa M, Fujita K, Sakakibara A, Kawamura M . Adenocarcinomas arising from uterine adenomyosis: a report of four cases. Int J Gynecol Pathol. 2002; 21(3):239-45. DOI: 10.1097/00004347-200207000-00006. View

Takeuchi K, Yamanaka Y, Hamana S, Ohara N, Maruo T . Invasive adenocarcinoma arising from uterine adenomyosis involving the rectosigmoid colon. Int J Gynecol Cancer. 2004; 14(5):1004-6. DOI: 10.1111/j.1048-891X.2004.14541.x. View

Olsen K . An unusual case of adenocarcinoma-adenomyosis of the uterus with diffuse embolic lung metastases. Acta Obstet Gynecol Scand. 1955; 34(3):269-72. DOI: 10.3109/00016345509157632. View

10.

Campbell R, Bhat-Nakshatri P, Patel N, Constantinidou D, Ali S, Nakshatri H . Phosphatidylinositol 3-kinase/AKT-mediated activation of estrogen receptor alpha: a new model for anti-estrogen resistance. J Biol Chem. 2001; 276(13):9817-24. DOI: 10.1074/jbc.M010840200. View

11.

Mori M, Furusawa A, Kino N, Uno M, Ozaki Y, Yasugi T . Rare case of endometrioid adenocarcinoma arising from cystic adenomyosis. J Obstet Gynaecol Res. 2014; 41(2):324-8. DOI: 10.1111/jog.12513. View

12.

Chene G, Ouellet V, Rahimi K, Barres V, Provencher D, Mes-Masson A . The ARID1A pathway in ovarian clear cell and endometrioid carcinoma, contiguous endometriosis, and benign endometriosis. Int J Gynaecol Obstet. 2015; 130(1):27-30. DOI: 10.1016/j.ijgo.2015.02.021. View

13.

Koike N, Tsunemi T, Uekuri C, Akasaka J, Ito F, Shigemitsu A . Pathogenesis and malignant transformation of adenomyosis (review). Oncol Rep. 2012; 29(3):861-7. DOI: 10.3892/or.2012.2184. View

14.

Wiegand K, Shah S, Al-Agha O, Zhao Y, Tse K, Zeng T . ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med. 2010; 363(16):1532-43. PMC: 2976679. DOI: 10.1056/NEJMoa1008433. View

15.

Goumenou A, Arvanitis D, Matalliotakis I, Koumantakis E, Spandidos D . Loss of heterozygosity in adenomyosis on hMSH2, hMLH1, p16Ink4 and GALT loci. Int J Mol Med. 2000; 6(6):667-71. DOI: 10.3892/ijmm.6.6.667. View

16.

Takeuchi K, Tateiwa H, Hamana S, Yoshida S, Kitazawa S, Maruo T . Invasive adenocarcinoma arising from adenomyosis in a septate uterus. Acta Obstet Gynecol Scand. 2006; 85(9):1146-7. DOI: 10.1080/00016340600609061. View

17.

Puppa G, Shozu M, Perin T, Nomura K, Gloghini A, Campagnutta E . Small primary adenocarcinoma in adenomyosis with nodal metastasis: a case report. BMC Cancer. 2007; 7:103. PMC: 1913924. DOI: 10.1186/1471-2407-7-103. View

18.

Abushahin N, Zhang T, Chiang S, Zhang X, Hatch K, Zheng W . Serous endometrial intraepithelial carcinoma arising in adenomyosis: a report of 5 cases. Int J Gynecol Pathol. 2011; 30(3):271-81. DOI: 10.1097/PGP.0b013e318200868e. View

19.

Winkelman J, Robinson R . Adenocarcinoma of endometrium involving adenomyosis. Report of an unusual case and review of the literature. Cancer. 1966; 19(7):901-8. DOI: 10.1002/1097-0142(196607)19:7<901::aid-cncr2820190703>3.0.co;2-0. View

20.

Taneichi A, Fujiwara H, Takahashi Y, Takei Y, Machida S, Saga Y . Influences of uterine adenomyosis on muscle invasion and prognosis of endometrioid adenocarcinoma. Int J Gynecol Cancer. 2014; 24(8):1429-33. DOI: 10.1097/IGC.0000000000000243. View