Galaal K, Kew F M, Tam K F, Lopes A, Meirovitz M, Naik R, Godfrey K A, Hatem M H, Edmondson R J
Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.
Eur J Obstet Gynecol Reprod Biol. 2009 Apr;143(2):88-92. doi: 10.1016/j.ejogrb.2008.12.014. Epub 2009 Feb 7.
The aims of this study were to determine the prognostic factors, survival outcomes and response to adjuvant therapy in women with uterine carcinosarcoma treated in a single institution.
This is a cohort study of women diagnosed with carcinosarcoma and treated at the Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. The medical records of all patients diagnosed with carcinosarcoma between January 1960 and July 2002 were reviewed.
A total of 93 women were identified during this period. The median age was 67 years. The most common presentation was abnormal vaginal bleeding, occurring in 85%, followed by pelvic mass in 45%, and abdominal pain in 38%. At surgery there was extra-uterine spread in 54% of women. The median follow-up was 33 months (range 4-146 months). Adjuvant therapy was not associated with survival advantage. Recurrence was diagnosed in 55 patients (59%) and the overall 5-year survival for all stages was 33%. On multivariate analysis depth of myometrial invasion, stage and pelvic nodes metastasis were associated with poor survival.
The poor outcome for these patients may reflect the aggressive nature of carcinosarcoma and that at the time of presentation more than 50% have extra-uterine disease, which was associated with significant poorer survival. Systemic adjuvant therapy has not been associated with significant improvement in the outcome. More studies are needed to better define the appropriate treatment for this rare cancer.
本研究旨在确定在单一机构接受治疗的子宫癌肉瘤女性患者的预后因素、生存结果及辅助治疗反应。
这是一项对在英国盖茨黑德伊丽莎白女王医院北部妇科肿瘤中心诊断并接受治疗的癌肉瘤女性患者的队列研究。回顾了1960年1月至2002年7月期间所有诊断为癌肉瘤的患者的病历。
在此期间共确定了93名女性患者。中位年龄为67岁。最常见的表现是异常阴道出血，占85%，其次是盆腔肿块，占45%，腹痛占38%。手术时54%的女性有子宫外扩散。中位随访时间为33个月（范围4 - 146个月）。辅助治疗与生存优势无关。55例患者（59%）诊断为复发，所有分期的总体5年生存率为33%。多因素分析显示，肌层浸润深度、分期和盆腔淋巴结转移与生存不良相关。
这些患者预后较差可能反映了癌肉瘤的侵袭性，且就诊时超过50%的患者有子宫外疾病，这与显著较差的生存相关。全身辅助治疗并未使结局有显著改善。需要更多研究来更好地确定这种罕见癌症的合适治疗方法。
