Livi L, Andreopoulou E, Shah N, Paiar F, Blake P, Judson I, Harmer C
Radiotherapy Department, Florence University, Florence, Italy.
Clin Oncol (R Coll Radiol). 2004 Jun;16(4):261-8. doi: 10.1016/j.clon.2004.01.010.
Uterine sarcomas are rare tumours with histopathological diversity characterised by rapid clinical progression and poor prognosis. Optimal management consists of complete surgical removal, but is not clear whether adjuvant radiotherapy improves the prognosis. The aim of this retrospective study was to investigate the clinical and histopathological characteristics together with treatment and outcome of patients with uterine sarcomas.
Records of 100 patients treated at the Royal Marsden Hospital between 1974-1998 were reviewed: 47 leiomyosarcoma (LMS), 30 mixed mullerian tumours (MMT), 19 endometrial stromal sarcoma (ESS), one haemangiopericytoma, one rhabdomyosarcoma and two unspecified sarcoma. There were 50, 11, 21 and 18 patients with stage I, II, III and IV carcinoma, respectively. Thirty-four patients had high-grade disease. Fifty-three patients received adjuvant radiotherapy. The median age was 55 years (range: 18-83 years). The median follow-up was 54 months (range: 3 months to 27 years).
The overall 3, 5 and 10-year survival rates were 39%, 30% and 20%, respectively. Survival was significantly related to stage (P = 0.002), grade (P = 0.003) and histological type (P = 0.04), but not to use of postoperative irradiation. At 3 years, the survival rate was 42% for LMS, 22% for MMT and 63% for ESS. Local recurrence rate, however, was significantly improved after adjuvant radiotherapy with dose higher than 50 Gy (P = 0.001).
Prognosis is dependent on histopathological sub-type, grade and tumour stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.
子宫肉瘤是一种罕见肿瘤，具有组织病理学多样性，其临床进展迅速，预后较差。最佳治疗方法是完整手术切除，但辅助放疗是否能改善预后尚不清楚。本回顾性研究的目的是调查子宫肉瘤患者的临床和组织病理学特征以及治疗情况和预后。
回顾了1974年至1998年间在皇家马斯登医院接受治疗的100例患者的记录：47例平滑肌肉瘤（LMS）、30例混合性苗勒管肿瘤（MMT）、19例子宫内膜间质肉瘤（ESS）、1例血管外皮细胞瘤、1例横纹肌肉瘤和2例未明确分类的肉瘤。分别有50例、11例、21例和18例患者处于I期、II期、III期和IV期癌症。34例患者为高级别疾病。53例患者接受了辅助放疗。中位年龄为55岁（范围：18至83岁）。中位随访时间为54个月（范围：3个月至27年）。
总体3年、5年和10年生存率分别为39%、30%和20%。生存率与分期（P = 0.002）、分级（P = 0.003）和组织学类型（P = 0.04）显著相关，但与术后放疗的使用无关。3年时，LMS的生存率为42%，MMT为22%，ESS为63%。然而，辅助放疗剂量高于50 Gy后，局部复发率显著降低（P = 0.001）。
预后取决于组织病理学亚型、分级和肿瘤分期。辅助放疗可降低局部复发率，但对生存率无显著影响。
