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The Effect of Adenomyosis in Myometrial Invasion and Overall Survival in Endometrial Cancer
  1. Muzaffer Sanci, MD,
  2. Selçuk Erkilinç, MD*,
  3. Enes Taylan, MD,
  4. Varol Gülseren, MD*,
  5. Gamze Erkilinç, MD,
  6. Tuğba Karadeniz, MD§,
  7. Mustafa Bağci, MD*,
  8. Orhan Temel, MD*,
  9. Ulaş Solmaz, MD* and
  10. Mehmet Gökçü, MD*
  1. * Division of Gynecologic Oncology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey;
  2. Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York; and
  3. Department of Pathology, Alsancak Nevvar Salih Işgören Hospital, Izmir, Turkey; and
  4. § Department of Pathology, University of Medical Sciences Tepecik Education and Research Hospital, Izmir, Turkey.
  1. Address correspondence and reprint requests to Selçuk Erkilinç, MD, University of Medical Sciences Tepecik Education and Research Hospital, Kazim Dirik Mahallesi, 35200, Bornova, Izmir, Turkey. E-mail: selcukerkilinc{at}


Aim The aim of this study was to evaluate whether adenomyosis had an effect on myometrial tumor invasion, stage of the disease, and survival in endometrial cancer.

Methods Endometrial cancer patients encountered between 2007 and 2016 were identified from pathology records. Patients who underwent suboptimal surgical or medical treatment or with insufficient clinical or surgical data were excluded. Patients diagnosed as having concurrent adenomyosis constituted the study group. Control group patients were randomly selected in a paired design according to the tumor grades in the study group, and for each tumor grade, 4 times as many as patients were included. Tumor stage, histologic type and grade, myometrial invasion, lymphovascular space invasion, presence and location of the adenomyosis in myometrial wall, distance from endometrial line, tumor in adenomyosis, adjuvant treatment, and relapse were primary outcomes.

Age, body mass index, medical comorbidities, and type of operation were also recorded. Univariate and multivariate Cox proportional hazards regression models were performed for overall survival.

Results Of those 1242 endometrial cancer patients, 80 with concurrent adenomyosis were identified and compared with 320 patients without adenomyosis following a paired selection based on tumor grade. Higher rates of myometrial invasion, lymphovascular space invasion, tumor diameter, and adjuvant treatments were found in the nonadenomyosis group compared with adenomyosis group (P ≤ 0.001). In patients with adenomyosis, rates of early-stage disease and overall survival were significantly higher compared with the control group (P = 0.001 and 0.01, respectively).

Conclusions Our results showed that adenomyosis is significantly associated with lower stage in endometrial cancer that may suggest a possible limiting effect on endometrial cancer spread. In addition, despite similar rates in disease-free survival and endometrial cancer–related death, overall survival rate was significantly higher in the presence of adenomyosis and might be considered as a good prognostic factor for endometrial cancer.

  • Adenomyosis
  • Concurrence
  • Endometrial cancer
  • Myometrial invasion
  • Overall survival

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  • The authors declare no conflicts of interest.