Machida Hiroko, Maeda Midori, Cahoon Sigita S, Scannell Christopher A, Garcia-Sayre Jocelyn, Roman Lynda D, Matsuo Koji
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA.
National Center for Global Health and Medicine, Tokyo, Japan.
Arch Gynecol Obstet. 2017 Jun;295(6):1459-1468. doi: 10.1007/s00404-017-4375-z. Epub 2017 Apr 25.
While adenomyosis is one of the most common benign histologic findings in hysterectomy specimens of endometrial cancer, demographics of endometrial cancer arising in adenomyosis (EC-AIA) has not been well elucidated. The aim of this study is to evaluate histopathological findings and disease-free survival (DFS) of EC-AIA in comparison to endometrial cancer coexisting with adenomyosis (EC-A).
EC-AIA cases were identified via a systematic literature search (n = 46). EC-A cases were identified from a historical cohort that underwent hysterectomy-based surgical staging in two institutions (n = 350). Statistical comparisons of the two groups were based on univariate and multivariate analyses.
The EC-AIA group was significantly older than the EC-A group (58.9 versus 53.8, p = 0.002). As to tumor characteristics, 63.6% of EC-AIA cases reported tumor within the myometrium without endometrial extension. The EC-AIA group was significantly associated with more non-endometrioid histology (23.9 versus 14.8%; p = 0.002) and deep myometrial tumor invasion (51.6 versus 19.4%; p < 0.001) than EC-A. Tumor grade, stage, and nodal metastasis risk were similar (all, p > 0.05). In a univariate analysis, the EC-AIA group had a significantly decreased DFS compared to EC-A (5-year rates, 72.2 versus 85.5%, p = 0.001). After controlling for age, histology, tumor grade, and stage, EC-AIA remained an independent prognostic factor associated with decreased DFS compared to EC-A (adjusted-hazard ratio 2.87, 95% confidence interval 1.44-5.70, p = 0.031).
Our study demonstrated that EC-AIA has distinct tumor characteristics and a poorer survival outcome compared to EC-A. This suggests a benefit of recognition of this unique entity as an aggressive variant of endometrial cancer.
虽然子宫腺肌病是子宫内膜癌子宫切除标本中最常见的良性组织学表现之一，但子宫腺肌病合并子宫内膜癌（EC-AIA）的人口统计学特征尚未得到充分阐明。本研究的目的是评估EC-AIA与合并子宫腺肌病的子宫内膜癌（EC-A）相比的组织病理学发现和无病生存期（DFS）。
通过系统文献检索确定EC-AIA病例（n = 46）。从两个机构接受基于子宫切除术的手术分期的历史队列中确定EC-A病例（n = 350）。两组的统计比较基于单变量和多变量分析。
EC-AIA组明显比EC-A组年龄大（58.9岁对53.8岁，p = 0.002）。关于肿瘤特征，63.6%的EC-AIA病例报告肿瘤位于肌层内，无子宫内膜浸润。与EC-A相比，EC-AIA组与更多的非子宫内膜样组织学（23.9%对14.8%；p = 0.002）和更深的肌层肿瘤浸润（51.6%对19.4%；p < 0.001）显著相关。肿瘤分级、分期和淋巴结转移风险相似（均p > 0.05）。在单变量分析中，与EC-A相比，EC-AIA组的DFS显著降低（5年率，72.2%对85.5%，p = 0.001）。在控制年龄、组织学、肿瘤分级和分期后，与EC-A相比，EC-AIA仍然是与DFS降低相关的独立预后因素（调整后风险比2.87，95%置信区间1.44 - 5.70，p = 0.031）。
我们的研究表明，与EC-A相比，EC-AIA具有独特的肿瘤特征和较差的生存结果。这表明将这一独特实体识别为子宫内膜癌的侵袭性变体是有益的。
