Temkin S M, Hellmann M, Lee Y-C, Abulafia O
Division of Gynecologic Oncology, SUNY, State University of New York-Downstate, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
Int J Gynecol Cancer. 2007 Jan-Feb;17(1):215-9. doi: 10.1111/j.1525-1438.2006.00762.x.
Carcinosarcoma is a rare tumor of the uterus with a poor prognosis, even when identified and treated at an early stage. The purpose of this study was to identify and analyze prognostic pathologic features and treatment outcomes in patient with stages I and II carcinosarcoma of the uterus. Patients with carcinosarcoma of the uterus who received primary surgical treatment between 1984 and 2004 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/II disease following hysterectomy and selective pelvic and para-aortic lymph node sampling. Regression analysis was used to determine risk factors for recurrence and survival. Disease-free and overall survival were then determined using Kaplan-Meier analysis. Forty-seven patients with stages I and II carcinosarcoma of the uterus were identified. Age, heterologous or homologous histology, and type of adjuvant treatment were not associated with recurrence or survival. Depth of myometrial invasion was found to correlate to disease-free survival but not overall survival. The number of lymph nodes collected correlated to risk of recurrence and survival. Disease-free and overall survival were greater in patients with higher lymph node count. We conclude that the number of lymph nodes collected was the only risk factor that was found to be correlated to recurrence and survival in patients with early-stage carcinosarcoma. These results support mounting evidence that lymphadenectomy is crucial in patients with carcinomas of the uterus in order to discover occult metastatic disease and potentially provide patients with a therapeutic benefit.
子宫癌肉瘤是一种罕见的子宫肿瘤，预后较差，即使在早期被发现并接受治疗也是如此。本研究的目的是识别和分析Ⅰ期和Ⅱ期子宫癌肉瘤患者的预后病理特征及治疗结果。通过机构肿瘤登记处确定了1984年至2004年间接受初次手术治疗的子宫癌肉瘤患者。纳入标准为子宫切除术后临床分期为Ⅰ/Ⅱ期疾病以及选择性盆腔和腹主动脉旁淋巴结取样。采用回归分析来确定复发和生存的危险因素。然后使用Kaplan-Meier分析确定无病生存期和总生存期。确定了47例Ⅰ期和Ⅱ期子宫癌肉瘤患者。年龄、异源性或同源性组织学以及辅助治疗类型与复发或生存无关。发现肌层浸润深度与无病生存期相关，但与总生存期无关。收集的淋巴结数量与复发风险和生存相关。淋巴结计数较高的患者无病生存期和总生存期更长。我们得出结论，收集的淋巴结数量是唯一被发现与早期癌肉瘤患者的复发和生存相关的危险因素。这些结果支持越来越多的证据表明，淋巴结清扫术对于子宫癌患者至关重要，以便发现隐匿性转移性疾病并可能为患者提供治疗益处。
