Pelmus Manuela, Penault-Llorca Frédérique, Guillou Louis, Collin Françoise, Bertrand Gérard, Trassard Martine, Leroux Agnès, Floquet Anne, Stoeckle Eberhard, Thomas Laurence, MacGrogan Gaëtan
Department of Pathology, University Hospital of Sherbrooke, Quebec, Canada.
Int J Gynecol Cancer. 2009 Apr;19(3):385-90. doi: 10.1111/IGC.0b013e3181a1bfbc.
Uterine leiomyosarcomas (LMSs) are rare cancers representing less than 1% of all uterine malignancies. Clinical International Federation of Gynecology and Obstetrics (FIGO) stage is the most important prognostic factor. Other significant prognostic factors, especially for early stages, are difficult to establish because most of the published studies have included localized and extra-pelvian sarcomas. The aim of our study was to search for significant prognostic factors in clinical stage I and II uterine LMS. The pathologic features of 108 uterine LMS including 72 stage I and II lesions were reviewed using standardized criteria. The prognostic significance of different pathologic features was assessed. The median follow-up in the whole group was 64 months (range, 6-223 months). The 5-year overall survival (OS) and metastasis-free interval and local relapse-free interval rates in the whole group and early-stage group (FIGO stages I and II) were 40% and 57%, 42% and 50%, 56% and 62%, respectively. Clinical FIGO stage was the most important prognostic factor for OS in the whole group (P = 4 x 10). In the stage I and II group, macroscopic circumscription was the most significant factor predicting OS (P = 0.001). In the same group, mitotic score and vascular invasion were associated with metastasis-free interval (P = 0.03 and P = 0.04, respectively). Uterine LMSs diagnosed using standardized criteria have a poor prognosis, and clinical FIGO stage is an ominous prognostic factor. In early-stage LMS, pathologic features such as mitotic score, vascular invasion, and tumor circumscription significantly impact patient outcome.
子宫平滑肌肉瘤（LMS）是罕见的癌症，占所有子宫恶性肿瘤的比例不到1%。国际妇产科联盟（FIGO）临床分期是最重要的预后因素。其他重要的预后因素，尤其是早期的预后因素，很难确定，因为大多数已发表的研究纳入的是局限性和盆腔外的肉瘤。我们研究的目的是寻找临床I期和II期子宫LMS的重要预后因素。使用标准化标准对108例子宫LMS的病理特征进行了回顾，其中包括72例I期和II期病变。评估了不同病理特征的预后意义。全组的中位随访时间为64个月（范围6 - 223个月）。全组和早期组（FIGO I期和II期）的5年总生存率（OS）、无转移间期和无局部复发病间期率分别为40%和57%、42%和50%、56%和62%。临床FIGO分期是全组OS最重要的预后因素（P = 4×10）。在I期和II期组中，大体边界清晰是预测OS的最显著因素（P = 0.001）。在同一组中，核分裂象评分和血管侵犯与无转移间期相关（分别为P = 0.03和P = 0.04）。使用标准化标准诊断的子宫LMS预后较差，临床FIGO分期是一个不良的预后因素。在早期LMS中，核分裂象评分、血管侵犯和肿瘤边界等病理特征对患者预后有显著影响。
