Co-existence of leiomyomas, adenomyosis and endometriosis in women with endometrial cancer

Sharon E Johnatty,Colin J R Stewart,Deborah Smith,Anthony Nguyen,John O' Dwyer,Tracy A O'Mara,Penelope M Webb,Amanda B Spurdle

doi:10.1038/s41598-020-59916-1

Abstract

Leiomyomas, adenomyosis, and endometriosis are reported to be risk factors for endometrial carcinoma (EC), and adenomyosis and endometriosis also for ovarian carcinoma (OC). We aimed to describe the prevalence of these conditions in EC patients with or without an OC diagnosis, and to investigate their relationship with EC risk and prognostic factors in these patients. We evaluated the co-existence of these three conditions in 1399 EC patients, and compared the prevalence of epidemiological risk factors and tumor prognostic features in patients with each condition versus not. Prevalence of conditions was also assessed in the subset of patients with prior/concurrent OC. The observed coexistence of leiomyomas, adenomyosis and endometriosis significantly deviated from that expected (P = 1.2 × 10−8). Patients were more likely to: report a younger age at menarche (PTrend = 0.004) if they had leiomyomas; have used oral contraceptives (P = 6.6 × 10−5) or had ≥2 full-term pregnancies (PTrend = 2.0 × 10−9) if they had adenomyosis; be diagnosed with EC at younger age (P = 5.0 × 10−11) if they had endometriosis. Patients with prior/concurrent OC were more likely to be diagnosed at younger age (P = 5.0 × 10−5), have endometriosis (P = 9.9 × 10−7), and present with higher stage EC (PTrend = 6.6 × 10−5). These findings justify further consideration of these gynecologic conditions as independent risk and prognostic factors for EC.

Highlights

Leiomyomas, adenomyosis, and endometriosis are reported to be risk factors for endometrial carcinoma (EC), and adenomyosis and endometriosis for ovarian carcinoma (OC)
Our descriptive analysis of leiomyomas, adenomyosis and endometriosis in 1399 EC patients participating in the Australian National Endometrial Cancer Study (ANECS) population-based study highlights how common these conditions are in EC patients, provides evidence for their co-occurrence, and describes their relationship with known EC risk and prognostic factors
Given the known association between endometriosis and OC, we present a secondary exploratory analysis of these conditions in a subset of EC patients with prior or concurrent OC

Summary

Introduction

Leiomyomas, adenomyosis, and endometriosis are reported to be risk factors for endometrial carcinoma (EC), and adenomyosis and endometriosis for ovarian carcinoma (OC). These findings justify further consideration of these gynecologic conditions as independent risk and prognostic factors for EC. We conducted a case-only descriptive analysis that: (i) assessed co-existence of leiomyomas, adenomyosis and endometriosis in EC patients; (ii) compared EC risk factors and tumor prognostic features for women with EC identified to have no evidence of leiomyomas, adenomyosis or endometriosis versus subgroups annotated as having one, two or all three of these conditions at/before EC diagnosis; (iii) evaluated overall and EC-specific survival for these patient subgroups; (iv) assessed if these three conditions were overrepresented in the subset of women with report of OC prior to or concurrent with their EC diagnosis

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