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低级别子宫内膜间质肉瘤:激素方面

Low-grade endometrial stromal sarcoma: hormonal aspects.

作者信息

Chu Micheline C, Mor Gil, Lim Chungyun, Zheng Wenxin, Parkash Vinita, Schwartz Peter E

机构信息

Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520, USA.

出版信息

Gynecol Oncol. 2003 Jul;90(1):170-6. doi: 10.1016/s0090-8258(03)00258-0.

Abstract

OBJECTIVE

The goal of this work was to determine whether exposure to estrogen following treatment of low-grade endometrial stromal sarcomas affects clinical outcome.

METHODS

Twenty-two patients with low-grade endometrial stromal sarcomas were reviewed to determine whether they were exposed to exogenous or endogenous estrogen and/or progestins following their diagnosis and whether exposure to these hormones might have influenced their prognosis. Estrogen receptor (ER) alpha and beta and progestin receptor (PR) status were analyzed from paraffin-embedded tissue by immunohistochemistry and ER mRNA was measured in fresh tissue by reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

Ten of the twenty-two patients with low-grade endometrial stromal sarcomas developed recurrent disease. Four of five patients (80%) who received estrogen replacement therapy (ERT) recurred. Four of eight patients (50%) with retained ovaries recurred. Eight of the ten specimens available for analysis were positive for ERalpha, none were positive for ERbeta, and 9 of 10 were positive for PR. Four of thirteen patients who received progestins as adjuvant therapy recurred, compared with 6 of 9 patients who did not receive progestins (31% vs 67%). Eight recurrences were treated with progestin therapy and 7 (88%) of them had either stable disease (3/8, 38%) or complete response (4/8, 50%).

CONCLUSIONS

Our results suggest that ERT may be detrimental in patients with low-grade endometrial stromal sarcoma. Retention of normally functioning ovaries, on the other hand, may not significantly affect the recurrence rate following hysterectomy alone in Stage I patients. The lack of ERbeta expression in endometrial stromal sarcomas compared with normal endometrial stromal cells suggests that loss of ERbeta may be a marker for malignancy. Progestin therapy should be routinely considered for adjuvant therapy and for the treatment of recurrent endometrial stromal sarcomas.

摘要

目的

本研究旨在确定低级别子宫内膜间质肉瘤治疗后接触雌激素是否会影响临床结局。

方法

回顾性分析22例低级别子宫内膜间质肉瘤患者,以确定其诊断后是否接触外源性或内源性雌激素和/或孕激素,以及接触这些激素是否可能影响其预后。通过免疫组织化学分析石蜡包埋组织中的雌激素受体(ER)α和β以及孕激素受体(PR)状态,并通过逆转录聚合酶链反应(RT-PCR)测量新鲜组织中的ER mRNA。

结果

22例低级别子宫内膜间质肉瘤患者中有10例出现复发。接受雌激素替代疗法(ERT)的5例患者中有4例(80%)复发。保留卵巢的8例患者中有4例(50%)复发。可用于分析的10个标本中有8个ERα呈阳性,无ERβ呈阳性,10个中有9个PR呈阳性。接受孕激素辅助治疗的13例患者中有4例复发,未接受孕激素治疗的9例患者中有6例复发(31%对67%)。8例复发患者接受了孕激素治疗,其中7例(88%)病情稳定(3/8,38%)或完全缓解(4/8,50%)。

结论

我们的结果表明,ERT可能对低级别子宫内膜间质肉瘤患者有害。另一方面,保留功能正常的卵巢可能不会显著影响I期患者单纯子宫切除术后的复发率。与正常子宫内膜间质细胞相比,子宫内膜间质肉瘤中缺乏ERβ表达表明ERβ缺失可能是恶性肿瘤的一个标志物。孕激素治疗应常规用于辅助治疗和复发性子宫内膜间质肉瘤的治疗。

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