Clinicopathologic Characteristics And Prognosis Of Endometrial Carcinoma Patients With Adenomyosis

Objective:To compare and analyze the clinicopathological characteristics and survival prognosis of endometrial cancer with and without adenomyosis,including general clinical data,clinical manifestations,imaging and pathological characteristics,and survival prognosis.To explore the influencing factors between adenomyosis and endometrial cancer.Methods:This study retrospectively collected patients with endometrial cancer diagnosed surgically and pathologically at Affiliated Hospital of Guilin Medical College Hospital from January 2017 to May 2022 as research subjects.Endometrial cancer patients with adenomyosis were included in the observation group,while endometrial cancer patients without adenomyosis were included in the control group.The differences between the two groups in general clinical data,clinical manifestations,imaging and pathological characteristics,and prognosis and survival data were analyzed.Statistical methods were performed using SPSS26.0 statistical software χ2 test,Fisher exact probability method,nonparametric rank sum test,Kaplan Meier curve,and Log Rank χ2 Analysis.Results:1.Patients were screened in strict accordance with the inclusion and exclusion criteria,and a total of 391 patients were included.There were 54 cases in the observation group,accounting for 13.8%of the total population,while there were 337 cases in the control group,accounting for 86.2%of the total population.Compare the general clinical data,imaging data,and tumor markers of the two groups of patients:The myometrial thickness of patients in the observation group was[2.90(2.28,3.50)cm vs.2.5(2.0,3.0)cm,P=0.020],the proportion of patients without menopause(63%vs 47.8%,P=0.038),and the proportion of patients seeking medical attention due to "menstrual disorders"(25.9%vs 15.1%,P=0.048),which were higher than those in the control group.The difference was statistically significant.Among patients undergoing MRI examination,there was no statistically significant difference in the proportion of patients with endometrial lumpy abnormal signal shadows reported by MRI between the two groups(P=0.967);The proportion of patients with preoperative MRI diagnosis in the observation group was lower than that in the control group(73.9%vs 93.0%,P<0.001),and the proportion of patients with no abnormal endometrium reported by MRI was higher than that in the control group(30.6%vs 11.6%,P=0.003),with a statistically significant difference.There was no statistically significant difference in the positive rates of tumor markers CA125,CA199,and HE-4 between the two groups(P=0.069,P=0.291,P=0.462,P=0.152,P=0.462);However,there was a statistically significant difference in HE-4 values between the two groups of patients[54.14(45.88,70.50)pmol/mL vs.63.87(49.65,85.23)pmol/mL,P=0.039].2.Compare the pathological data of the two groups of patients:In the pathological data,the proportion of patients in the observation group with endometrial cancer stage IA and IB(85.2%vs 60.8%,5.6%vs 17.2%,P=0.001,P=0.028),and the proportion of patients with FIGO grade 1(70.4%vs 52.8%,P=0.016)were higher than those in the control group.The proportion of patients with deep myometrial invasion and LVSI positive were lower than those in the control group(11.1%vs 26.4%,9.3%vs 24.9%,P=0.015),with significant differences.In comparison of lymph node resection methods,the proportion of patients with pelvic lymph node resection in the observation group was higher than that in the control group,and the proportion of patients with paraaortic lymph node resection was lower than that in the control group,with significant differences(P=0.034,P<0.001).However,there was no significant difference in the number of positive lymph nodes and the positive rate of lymph nodes among lymph node positive patients(P>0.05).Immunohistochemical data showed that there was no statistically significant difference between the two groups in microsatellite stability,P53 properties,and ER(both P>0.05).The percentage of Ki67 positive was lower than that of the control group,and the percentage of PR positive was higher than that of the control group.The difference was statistically significant[30(20,50)%vs.50(30,60)%,50(30,80)%vs.30(10,70)%,P<0.001,P=0.005].3.Compare the survival data of the two groups of patients:The 3-year overall survival rate and disease-free survival rate of patients in the observation group were higher than those in the control group,but the difference was not statistically significant(100.0%vs 95.0%,100%vs 93.4%,P=0.609,P=0.372);There was no statistically significant difference between the total survival curve and disease free survival curve of patients in the observation group and the two groups(Total survival Log Rank χ2=1.746,χ2=0.186;Log Rank χ2=1.053,P=0.305).Conclusions:The majority of endometrial cancer patients with adenomyosis are not menopausal and seek medical attention with menstrual disorders as the first symptom.The value of tumor marker HE-4 is lower,the thickness of the myometrium is larger,and MRI findings are more atypical,leading to misdiagnosis and missed diagnosis.Endometrial cancer patients with adenomyosis often exhibit high differentiation of tumor cells,less deep myometrial invasion,less LVSI positive,a smaller range of lymph nodes requiring resection,a lower Ki67 positive ratio,a higher PR positive rate,and fewer high-risk factors associated with cancer.