Prevalence of adenomyosis in endometrial cancer patients: a systematic review and meta-analysis
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REVIEW
Prevalence of adenomyosis in endometrial cancer patients: a systematic review and meta‑analysis Antonio Raffone1 · Renato Seracchioli2 · Diego Raimondo2 · Manuela Maletta2 · Antonio Travaglino3 · Ivano Raimondo4,5 · Ilaria Giaquinto2 · Benedetta Orsini2 · Luigi Insabato3 · Massimiliano Pellicano1 · Fulvio Zullo1 Received: 24 June 2020 / Accepted: 13 October 2020 © The Author(s) 2020
Abstract Introduction Several studies have assessed the histological co-existence of endometrial carcinoma (EC) and adenomyosis. However, the significance of this association is still unclear. Objective To assess the prevalence of adenomyosis in women with EC for a better understanding of the association between the two diseases. Materials and methods A systematic review and meta-analysis was performed by searching electronics databases from their inception to March 2020, for all studies that allowed extraction of data about prevalence of adenomyosis in EC patients. Adenomyosis prevalence was calculated for each included study and as pooled estimate, with 95% confidence interval (CI). Results Eight retrospective cohort studies assessing 5573 EC patients were included in our analysis. Of total, 1322 were patients with adenomyosis, and 4251 were patients without adenomyosis. Pooled prevalence of adenomyosis in EC patients was 22.6% (95% CI 12.7–37.1%). Conclusion Adenomyosis prevalence in EC patients was not different from that reported for other gynecological conditions. The supposed association between the two diseases appears unsupported. Keywords Endometrium · Myometrium · Tumor · Malignancy · Gynecology · Oncology
Introduction
* Diego Raimondo [email protected] 1
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
2
Gynecology and Human Reproduction Physiopathology, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
3
Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
4
Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
5
School in Biomedical Sciences, University of Sassari, Sassari, Italy
Adenomyosis is a benign gynecologic condition, defined as the migration of glands and stroma from basal layer of the endometrium to the myometrium [1]. Exposure to estrogens, parity and prior uterine surgery are considered as risk factors for the disease [1]. The most popular theory is that the alteration or absence of the endometrial–myometrial interface (junctional zone) may promote the pathological invagination of the endometrial mucosa into the muscle fibers of the myometrium [2]. Heavy menstrual bleeding and dysmenorrhea are main clinical manifestations, while infertility, dyspareunia and chronic pelvic pain are less common. Nevertheless, one-third of patients are a
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