Peiffert D, Pernot M, Guillemin F, Luporsi E, Parache R M, Legras B, Bey P
Centre de lutte contre le Cancer, Vandoeuvre-lès-Nancy.
J Gynecol Obstet Biol Reprod (Paris). 1991;20(7):933-40.
Mixed Mullerian Tumours (MMT) of the endometrium have a bad reputation as far as prognosis is concerned. We have studied 34 cases of MMT treated between 1976 and 1988 and have compared their outcome with a matched series of 68 cases of adenocarcinoma (ADC). These were taken out of 880 cases of ADC treated during this period of time after matching them for the stage, the type of treatment, the year of treatment and the age of the patient. The curves of survival and the totals of survival were determined using Kaplan-Meier's method and also compared using Logrank's test. The 5-years overall survival was 18% for MMT as against 55% for ADC (p less than 0.001). The difference was equally significant statistically in terms of specific survival without recurrences. The 16 patients in stages I and II who were treated with the same protocol as used for ADC were matched against 32 cases of ADC taken out of the 680 cases ADC in stages I and II and treated by the same protocol (84%). After five years MMT had a higher number of survivors (35% overall, 45% with specific survival and 35% without recurrences), but the difference with survival of ADC was as significant (respectively 75, 85, 85%). Recurrences of MMT were frequent (62%), with metastases in 9 out of 10 and early (50%), in every respect opposed with recurrences of ADC (16%) which were in three out of five cases localized and late (after 10 months). These figures make one have to think of modifying the way MMT is treated. External pelvic radiotherapy should be carried out before any other treatment. The place for other methods of therapy is to be discussed.
就预后而言，子宫内膜混合性苗勒管肿瘤（MMT）名声不佳。我们研究了1976年至1988年间治疗的34例MMT病例，并将其结果与68例腺癌（ADC）的配对系列进行了比较。这些腺癌病例是从该时期治疗的880例ADC病例中选取的，根据分期、治疗类型、治疗年份和患者年龄进行匹配。使用Kaplan-Meier方法确定生存曲线和总生存率，并使用Logrank检验进行比较。MMT的5年总生存率为18%，而ADC为55%（p小于0.001）。在无复发的特定生存率方面，差异在统计学上同样显著。16例I期和II期MMT患者采用与ADC相同的方案治疗，并与680例I期和II期ADC中选取的32例采用相同方案治疗的ADC患者进行配对（84%）。五年后，MMT的存活者数量更多（总生存率为35%，特定生存率为45%，无复发率为35%），但与ADC生存率的差异同样显著（分别为75%、85%、85%）。MMT的复发很常见（62%），10例中有9例发生转移且转移较早（50%），这在各方面都与ADC的复发情况相反（16%），ADC的复发在五分之三的病例中局限且较晚（10个月后）。这些数据促使人们思考修改MMT的治疗方式。在进行任何其他治疗之前，应先进行盆腔外放疗。其他治疗方法的地位有待讨论。
