Vaidya Ami P, Horowitz Neil S, Oliva Esther, Halpern Elkan F, Duska Linda R
Division of Gynecologic Oncology, Gillette Center for Women's Cancers, Massachusetts General Hospital, Boston, MA 02114, USA.
Gynecol Oncol. 2006 Nov;103(2):684-7. doi: 10.1016/j.ygyno.2006.05.009. Epub 2006 Jun 23.
Uterine mixed malignant mullerian tumors (MMMT) have traditionally been excluded from clinical trials of endometrial cancer because of a belief that they are more correctly included in the sarcoma category. Recently, investigators have suggested that uterine MMMTs are actually dedifferentiated epithelial tumors and should be treated as such. The current study was undertaken to compare outcomes, stage for stage, of uterine MMMT with poor prognosis endometrial adenocarcinomas.
Cases of MMMT from 1996 to 2004 were identified from the Tumor Registry after IRB consent was obtained. Retrospective chart review was performed. Cases were matched by age, stage, performance status, and surgical procedure to controls consisting of grade 3 endometrioid, papillary serous, and clear cell endometrial carcinomas from the same time period. Overall survival was compared using the Log-Rank test.
68 patients with MMMT were identified. 23 were excluded due to incomplete records. Patients with MMMT ranged in age from 51 to 95 years (mean 75.3 years). Approximately half of the patients (53%) had stage III or IV disease. Of the controls, 31 (69%) had grade 3 endometrioid, 11 (24%) papillary serous, and 3 (7%) clear cell carcinoma. Median overall survival for all patients with MMMT was significantly shorter than for controls, 18 months (range 0.5-72) versus 36 months (range 0.5-123) (P = 0.02). Patients with early stage disease (stage I or II) had shorter median survival than controls, 26 months (range 3-7) vs. 95 months (range 4-123) (P = 0.003). There was no difference in median survival when comparing advanced disease (stage III or IV) to matched controls, 15 months (range 0.5-70) vs. 19 months (range 0.5-100) (P = NS).
Patients with uterine MMMT have a poorer prognosis than those patients with high grade epithelial tumors, especially for those with early stage disease. Given the discrepancy in survival, these patients should not be included in studies of endometrial carcinoma. Further investigations are necessary to identify factors to improve survival of these patients.
子宫混合性恶性苗勒管肿瘤（MMMT）传统上被排除在子宫内膜癌临床试验之外，因为人们认为它们更应归类于肉瘤范畴。最近，研究人员提出子宫MMMT实际上是去分化上皮性肿瘤，应如此进行治疗。本研究旨在逐阶段比较子宫MMMT与预后不良的子宫内膜腺癌的结局。
在获得机构审查委员会（IRB）同意后，从肿瘤登记处识别出1996年至2004年的MMMT病例。进行回顾性病历审查。病例按年龄、分期、体能状态和手术方式与同期的3级子宫内膜样癌、乳头状浆液性癌和透明细胞子宫内膜癌组成的对照组进行匹配。使用对数秩检验比较总生存期。
共识别出68例MMMT患者。23例因记录不完整被排除。MMMT患者年龄范围为51至95岁（平均75.3岁）。约一半患者（53%）患有III期或IV期疾病。在对照组中，31例（69%）为3级子宫内膜样癌，11例（24%）为乳头状浆液性癌，3例（7%）为透明细胞癌。所有MMMT患者的中位总生存期显著短于对照组，分别为18个月（范围为0.5至72个月）和36个月（范围为0.5至123个月）（P = 0.02）。早期疾病（I期或II期）患者的中位生存期短于对照组，分别为26个月（范围为3至7个月）和95个月（范围为4至123个月）（P = 0.003）。将晚期疾病（III期或IV期）与匹配的对照组比较时，中位生存期无差异，分别为15个月（范围为0.5至70个月）和1个月（范围为0.5至100个月）（P =无显著性差异）。
子宫MMMT患者的预后比高级别上皮性肿瘤患者差，尤其是早期疾病患者。鉴于生存期的差异，这些患者不应纳入子宫内膜癌研究。有必要进一步研究以确定改善这些患者生存期的因素。
