Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis
Min Sung An, Hua Duan, Ying Zhang
Abstract
Abstract Objective Published data on the impact of co‐existent adenomyosis on the prognosis of patients with endometrial cancer remains elusive, with studies reporting conflicting results. We conducted this meta‐analysis to evaluate the prognostic significance of co‐existent adenomyosis on clinical outcomes and tumor characteristics of endometrial cancer patients. Methods A comprehensive literature review of multiple databases was conducted; quality assessment of eligible studies was performed by the Newcastle‐Ottawa scale (NOS). The outcomes of interest were compared in endometrial cancer patients with or without adenomyosis. Hazards ratios (HR) and Odds ratios (OR) with 95% confidence interval (CI) were calculated as a measure of effects. Results Fourteen retrospective observational studies comprising 1308 endometrial cancer patients with adenomyosis and 3734 patients without adenomyosis were included in this meta‐analysis. Results indicated that endometrial cancer patients with adenomyosis was significantly associated with an increased overall survival rate (HR = 0.51; 95% CI = 0.38–0.69; P < 0.00001), but not with disease‐free survival rate (HR = 0.68; 95% CI = 0.30–1.53; P = 0.35); besides, significantly associated with decreased ratio of deep myometrial invasion (OR = 0.45; 95% CI = 0.33–0.60; P < 0.00001), lymphovascular space invasion (OR = 0.44; 95% CI = 0.29–0.68; P = 0.0002), an increased ratio of histological grade 1 (OR = 1.84; 95% CI = 1.34–2.53; P = 0.0002) and FIGO I‐II (OR = 1.85; 95% CI = 1.49–2.30; P < 0.00001). However, there was no significant difference in pathological type and lymph node metastasis. There was a low to high heterogeneity with I 2 ranging from 0 to 67%. Conclusion This meta‐analysis indicated that co‐existent adenomyosis with endometrial cancer is associated with favorable tumor characteristics and could serve as a potential protective factor for the prognosis of endometrial cancer.