Matsuo Koji, Cahoon Sigita S, Gualtieri Marc, Scannell Christopher A, Jung Carrie E, Takano Tadao, Paulson Richard J, Muderspach Laila I, Roman Lynda D
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA,
Ann Surg Oncol. 2014 Dec;21(13):4246-55. doi: 10.1245/s10434-014-3880-6. Epub 2014 Jul 8.
To examine the effects of adenomyosis on tumor progression and survival outcome of endometrial cancer patients.
This is a retrospective study examining stage I-IV endometrial cancer patients who underwent hysterectomy-based surgical staging (n = 571), and endometrial hyperplasia patients who underwent hysterectomy (n = 213). Clinical demographics, histopathological factors, and survival outcomes were analyzed based on the presence or absence of adenomyosis.
Among the endometrial cancer cohort, adenomyosis was observed in 47.5 % of cases and was significantly associated with lower grade (grade 1-2 tumors, 81.2 vs. 73.3 %; p = 0.028), earlier stage (stage I disease, 74.8 vs. 64.3 %; p = 0.023), and lower likelihood of deep myometrial invasion (19.2 vs. 28.2 %; p = 0.039) and cervical invasion (13.7 vs. 21.2 %; p = 0.024) than those without adenomyosis. In survival analysis, endometrial cancer coexisting with adenomyosis was associated with a significantly better disease-free survival (5-year rate, 89.2 vs. 78.2 %; p < 0.001) and overall survival (91.8 vs. 83.9 %; p = 0.004) after hysterectomy. In multivariate analysis, controlling for other significant variables in univariate analysis, presence of adenomyosis remained an independent prognostic factor associated with decreased risk of disease recurrence after surgery (hazard ratio [HR] 0.53; 95 % confidence interval [CI] 0.30-0.92; p = 0.023). Endometrial hyperplasia had a significantly increased incidence of adenomyosis when compared with type I endometrial cancer (grade 1-2 endometrioid adenocarcinoma, n = 411) on multivariate analysis (62.9 vs. 48.9 %; HR 1.88; 95 % CI 1.32-2.69; p < 0.001).
Adenomyosis appears to be associated with less aggressive tumor behavior of endometrial cancer, suggesting that it may have inhibitory effects on the progression of this disease.
探讨子宫腺肌病对子宫内膜癌患者肿瘤进展及生存结局的影响。
这是一项回顾性研究，纳入接受基于子宫切除术的手术分期的I-IV期子宫内膜癌患者（n = 571）以及接受子宫切除术的子宫内膜增生患者（n = 213）。根据是否存在子宫腺肌病分析临床人口统计学、组织病理学因素及生存结局。
在子宫内膜癌队列中，47.5%的病例观察到子宫腺肌病，与无子宫腺肌病者相比，其与较低分级（1-2级肿瘤，81.2%对73.3%；p = 0.028）、较早分期（I期疾病，74.8%对64.3%；p = 0.023）以及子宫肌层深部浸润（19.2%对28.2%；p = 0.039）和宫颈浸润（13.7%对21.2%；p = 0.024）的可能性较低显著相关。在生存分析中，与子宫腺肌病共存的子宫内膜癌在子宫切除术后无病生存率（5年率，89.2%对78.2%；p < 0.001）和总生存率（91.8%对83.9%；p = 0.004）显著更好。在多变量分析中，在单变量分析中控制其他显著变量后，子宫腺肌病的存在仍然是与术后疾病复发风险降低相关的独立预后因素（风险比[HR] 0.53；95%置信区间[CI] 0.30 - 0.92；p = 0.023）。在多变量分析中，与I型子宫内膜癌（1-2级子宫内膜样腺癌，n = 411）相比，子宫内膜增生患者子宫腺肌病的发生率显著增加（62.9%对48.9%；HR 1.88；95% CI 1.32 - 2.69；p < 0.001）。
子宫腺肌病似乎与子宫内膜癌侵袭性较低的肿瘤行为相关，提示其可能对该疾病的进展具有抑制作用。
