Endometrial carcinoma risk prediction and gynecological comorbidity in adenomyosis: a 5648-case study

Adenomyosis frequently coexists with other gynecological diseases, but the full spectrum of comorbidities and malignant conditions in surgically treated patients remain uncharacterized. This study sought to delineate concurrent gynecological conditions in patients with histopathologically confirmed adenomyosis and to develop a risk stratification strategy for endometrial carcinoma (EC) in this specific population. A retrospective analysis was conducted on 5,648 women with histopathologically diagnosed adenomyosis who underwent either uterine-sparing or non-uterine-sparing surgery. Concurrent gynecological conditions were classified, with single counting for multiple comorbidities per category. Age and menopausal status were compared across subgroups; stratified analyses by age and menopausal status were performed for EC. Binary logistic regression was used to build predictive models, and model discrimination was assessed via the area under the ROC curve (AUC). Isolated adenomyosis was found in only 16.7% of cases, while 82.3% had at least one concurrent disease and 31.9% had two or more. Hysterectomy patients were significantly older than those who had uterine-sparing surgery. Uterine leiomyoma was the most common comorbidity (57.1%), followed by EC (11.81%). EC was strongly associated with older age and postmenopausal status, with an age-menopausal status composite index showing good discriminatory power for EC risk (AUC = 0.772). Most surgically treated patients had adenomyosis with other gynecological comorbidities, with a notable prevalence of EC. Age and menopausal status are reliable clinical factors that can effectively aid in the risk stratification of EC for patients with adenomyosis, providing a practical reference for clinical management.