{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:50:03Z","timestamp":1782730203693,"version":"3.54.5"},"reference-count":15,"publisher":"FapUNIFESP (SciELO)","issue":"4","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: The aim of this study was to determine whether adenomyosis is an independent prognostic factor in cervical cancer using integrated survival analysis and machine-learning models.  METHODS: This retrospective cohort study included 131 patients with early-stage cervical cancer treated surgically between 2008 and 2020. Patients were stratified by the presence (n=28) or absence (n=103) of adenomyosis based on final histopathology. Kaplan-Meier curves and log-rank tests assessed overall survival. Independent prognostic factors were identified through multivariate Cox regression and logistic regression analyses, supplemented by machine-learning decision tree modeling to evaluate variable importance and model performance.  RESULTS: Women with adenomyosis had no significant differences in tumor size, histology, depth of stromal invasion, lymphovascular space invasion, parametrial involvement, lymph node metastasis, or International Federation of Gynecology and Obstetrics 2018 stage. Kaplan-Meier analysis demonstrated shorter overall survival in the adenomyosis group (median overall survival 31.3 vs. 64.8 months, log-rank p=0.045). Multivariate Cox regression identified age, tumor size, International Federation of Gynecology and Obstetrics stage III, histologic grade, lymphovascular space invasion, parametrial infiltration, and vaginal involvement as independent determinants of overall survival (all p&lt;0.05). Adenomyosis status did not retain prognostic significance after adjustment (HR 0.91, p=0.818). Decision tree models corroborated these findings, with International Federation of Gynecology and Obstetrics stage and tumor size emerging as the most influential predictors of survival and recurrence.  CONCLUSION: Although adenomyosis was associated with shorter overall survival in univariate analysis, it did not function as an independent prognostic factor after adjustment for established clinicopathological variables in both multivariate Cox regression and machine-learning decision tree models. These findings indicate that prognostic stratification in cervical cancer should remain guided by tumor burden, stage, and histopathological risk factors.<\/jats:p>","DOI":"10.1590\/1806-9282.20251656","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:42:45Z","timestamp":1782729765000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of adenomyosis in cervical cancer: insights from machine learning\u2013driven survival analysis"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4638-7907","authenticated-orcid":false,"given":"Cansu \u00d6nal","family":"Kanba\u015f","sequence":"first","affiliation":[{"name":"University of Health Sciences,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8099-8883","authenticated-orcid":false,"given":"Esra","family":"Keles","sequence":"additional","affiliation":[{"name":"University of Health Sciences,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6732-9413","authenticated-orcid":false,"given":"Esma \u00d6zacar","family":"Mert","sequence":"additional","affiliation":[{"name":"University of Health Sciences,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4722-0911","authenticated-orcid":false,"given":"Cansu Ergen\u00e7","family":"\u00d6zda\u015f","sequence":"additional","affiliation":[{"name":"Ankara Yildirim Beyazit University,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9540-2671","authenticated-orcid":false,"given":"Hatice K\u00fcbra","family":"Can","sequence":"additional","affiliation":[{"name":"Kelkit State Hospital,  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"6","key":"ref1","first-page":"394","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray F","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"ref2","series-title":"Cervical cancer","year":"2020"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"5549","DOI":"10.3390\/ijms26125549","article-title":"Human papillomavirus and other relevant \u0131ssues in cervical cancer pathogenesis","volume":"26","author":"Ray A","year":"2025","journal-title":"Int J Mol Sci"},{"issue":"9","key":"ref4","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1111\/jog.14371","article-title":"Prognostic significance of co-existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: a meta-analysis","volume":"46","author":"An M","year":"2020","journal-title":"J Obstet Gynaecol Res"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ygyno.2025.02.017","article-title":"Adenomyosis associated with endometrial cancer: possible correlation with pathological, immunohistochemical and molecular characteristics","volume":"195","author":"La Torre F","year":"2025","journal-title":"Gynecol Oncol"},{"issue":"6","key":"ref6","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00404-017-4375-z","article-title":"Endometrial cancer arising in adenomyosis versus endometrial cancer coexisting with adenomyosis: are these two different entities?","volume":"295","author":"Machida H","year":"2017","journal-title":"Arch Gynecol Obstet"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"2430707","DOI":"10.1080\/08941939.2024.2430707","article-title":"Association between adenomyosis and cervical cancer: a retrospective cohort study","volume":"37","author":"Yang T","year":"2024","journal-title":"J Invest Surg"},{"issue":"6","key":"ref8","doi-asserted-by":"crossref","first-page":"660","DOI":"10.6004\/jnccn.2020.0027","article-title":"NCCN guidelines \u0131nsights: cervical cancer, version 1.2020","volume":"18","author":"Abu-Rustum NR","year":"2020","journal-title":"J Natl Compr Canc Netw"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ijgo.12611","article-title":"Cancer of the cervix uteri","volume":"143","author":"Bhatla N","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"issue":"6","key":"ref10","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1080\/01443615.2022.2036959","article-title":"The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma","volume":"42","author":"Yetimalar MH","year":"2022","journal-title":"J Obstet Gynaecol"},{"issue":"2","key":"ref11","first-page":"118","article-title":"Does coexistence of endometrial cancer and adenomyosis affect survival outcomes? A retrospective cohort study","volume":"45","author":"Buyuksahin LG","year":"2024","journal-title":"Eur J Gynaecol Oncol"},{"issue":"5","key":"ref12","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.tjog.2023.07.004","article-title":"Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: a systematic review and meta-analysis","volume":"62","author":"Wang DG","year":"2023","journal-title":"Taiwan J Obstet Gynecol"},{"issue":"1","key":"ref13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/igc.0000000000001137","article-title":"The effect of adenomyosis in myometrial \u0131nvasion and overall survival in endometrial cancer","volume":"28","author":"Erkilin\u00e7 S","year":"2018","journal-title":"Int J Gynecol Cancer"},{"issue":"8","key":"ref14","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1097\/IGC.0000000000000243","article-title":"Influences of uterine adenomyosis on muscle invasion and prognosis of endometrioid adenocarcinoma","volume":"24","author":"Taneichi A","year":"2014","journal-title":"Int J Gynecol Cancer"},{"issue":"17","key":"ref15","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.3390\/cancers17172799","article-title":"Machine learning models for predicting gynecological cancers: advances, challenges, and future directions","volume":"17","author":"Garg P","year":"2025","journal-title":"Cancers (Basel)"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302026000402211&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:42:47Z","timestamp":1782729767000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302026000402211&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026]]}},"alternative-id":["S0104-42302026000402211"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20251656","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e20251656"}}