A commentary on Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? A systematic review and meta-analysis

Sep 21, 2026

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A commentary examines whether surgical procedures can improve prognosis for endometrial cancer arising in adenomyosis (EC-AIA). It summarizes background on endometrial cancer burden, key prognostic predictors, and the pathologic features and prevalence of adenomyosis. The text contrasts evidence from prior systematic review and case reports, discusses proposed mechanisms such as genetic and epigenetic influences, and highlights remaining uncertainties about prognostic impact.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Background and clinical context

Adenomyosis and its relationship to EC

Prior studies on lymphadenectomy and EC-AIA

Pathogenesis hypotheses and molecular considerations

Limitations and implications for future research

’Correspondence A commentary on ‘Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? A systematic review and meta-analysis’ Liming Zhou, MB* , Mai Li, MM, Jie Li, MM Endometrial cancer (EC) is the sixth most detected cancer and the 14th most prevalent cause of cancer death in women globally, affecting 2 . 8% of women at some point in their lifetime[1] . Patients typically present with uterine-conﬁned pathology and have high survival rates. The key predictors of cancer outcome are histological character, tumor grade and size, age, degree of myometrial invasion, lymph node involvement, and disease stage. One of the most prevalent pathological signs in hysterectomy tissues is known as adenomyosis, which spreads from the endometrium into the uterus, the myometrium, and the endometrial glands. With a varying prevalence of 12–66%[2], it is one of the most common ancillary histopathological results of EC, especially of the endometrioid histotype. Numerous studies have investigated whether adenomyosis is present in EC patients. Those who investigated the importance of adenomyosis in endometrial adenocarcinoma suggested that it had negative impacts on EC. However, in other studies, adenomyosis with EC has been linked to early-stage malignancy and extended surveillance. Furthermore, subsequent investigations have demonstrated that adenomyosis does not negatively affect the prognosis and questionnaires of EC patients. It is therefore still unclear whether EC and adenomyosis are related. Sun et al. [3] performed a systematic review and meta-analysis to explore the impact of lymphadenectomy on the prognosis of EC arising in adenomyosis (EC-AIA) . The results of the study indicated that for patients who are unexpectedly diagnosed with EC-AIA following hysterectomy for benign tumors, a second surgery of supplementary lymphadenectomy may be a better option. Koshiyama et al. [4] reported only four cases in 564 patients (0.74%) operated between 1981 and 2001 . Although the exact Reproductive Medicine Center, Women and Children ’s Hospital of Ningbo University, Zhejiang, People ’s Republic of China Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: Women and Children’s Hospital of Ningbo University, Zhejiang 315012, People ’s Republic of China. Tel.: +8613 605 883 969. [E-mail: zhou.li.ming@163.com](E-mail: zhou.li.ming@163.com) (L. Zhou). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2024) 110:4508–4509 Received 18 March 2024; Accepted 24 March 2024 Published online 9 April 2024 [http://dx.doi.org/10.1097/JS9.0000000000001435](http://dx.doi.org/10.1097/JS9.0000000000001435) cause of malignant transformation in adenomyosis is still unknown, several writers have suggested that genetic and epigenetic factors may be involved. Due to the absence of an anatomic set in the basal part of endometrial tissue, cancer ﬁrst develops within the myometrial part and smoothly spreads to the myometrial stromal layer. Cancer that has directly invaded themyometrial stromal tissue extends rapidly to the lymphatic and circulatory systems. However, many molecular elements of the malignant development of adenomyosis remain unknown. The relationship between adenomyosis and the disruption of heterozygosity in the DNA mismatch repair gene has only been brieﬂy described in research[5] . The present research has some drawbacks. First, there is adeﬁciency of pathological evaluation to differentiate between ECs with adenomyosis and ECs developing from a

FAQs

What is EC-AIA and why is it clinically important?

EC-AIA refers to endometrial cancer arising in adenomyosis. The commentary highlights that adenomyosis is common in endometrial cancer and may influence outcomes, but the relationship remains unclear.

What evidence is cited regarding surgical management for EC-AIA?

A prior systematic review and meta-analysis is discussed, suggesting that for patients unexpectedly diagnosed with EC-AIA after hysterectomy for benign tumors, a second surgery with supplementary lymphadenectomy may be beneficial.

What limitations are mentioned that affect interpretation of conclusions?

The commentary notes insufficient pathological evaluation to distinguish ECs with adenomyosis from ECs arising from adenomyosis foci, lack of assessment of POLE mutations, and that the study is retrospective, requiring further prospective validation.

Sep 21, 2026

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