Djordjevic B, Gien L T, Covens A, Malpica A, Khalifa M A
Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Pathology, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA.
Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Gynecol Oncol. 2009 Oct;115(1):32-36. doi: 10.1016/j.ygyno.2009.06.018. Epub 2009 Jul 28.
To examine the impact of the polypoid morphology of uterine carcinosarcoma on clinical outcome, as well as its relationship to well-established prognostic factors.
In a retrospective study of fifty eight patients with uterine carcinosarcoma treated with hysterectomy, we correlated the polypoid status of tumors with stage, lymphatic vascular invasion, myometrial invasion, size, carcinoma to sarcoma ratio, type of carcinomatous and sarcomatous components, disease free survival and overall survival.
By multivariate analysis, the polypoid status had no impact on disease free survival (p=0.8958), but approached significance as a positive predictor for overall survival (p=0.0569); patients in the polypoid group lived on average 14.9 months longer than those with non-polypoid tumors. Polypoid neoplasms had a smaller average size and grew to a smaller maximum size than the non-polypoid tumors. While non-polypoid tumors were either carcinoma or sarcoma predominant, polypoid tumors were mostly sarcoma predominant (p=0.0348). Polypoid carcinosarcomas also demonstrated an appreciably lesser extent of myometrial invasion (p=0.0019), a markedly lower rate of lymphatic vascular invasion (p=0.0002), and tended to present as early stage tumors (p=0.0265). Carcinomatous component in polypoid tumors tended to have pure or nearly pure (>or=90%) endometrioid histology (p=0.1608). There was no relationship between polypoid status and type of sarcomatous component (p=0.5299).
Polypoid carcinosarcomas differ from their non-polypoid counterparts in key histological parameters such as the carcinoma to sarcoma ratio, myometrial and lymphatic vascular invasion, stage and type of carcinomatous component. Patients with polypoid tumors may have a better survival outcome than those with non-polypoid tumors.
探讨子宫癌肉瘤的息肉样形态对临床结局的影响及其与已确立的预后因素的关系。
在一项对58例行子宫切除术治疗的子宫癌肉瘤患者的回顾性研究中，我们将肿瘤的息肉样状态与分期、淋巴管浸润、肌层浸润、大小、癌肉瘤比例、癌性和肉瘤性成分类型、无病生存期和总生存期进行了关联分析。
多因素分析显示，息肉样状态对无病生存期无影响（p = 0.8958），但作为总生存期的阳性预测指标接近显著水平（p = 0.0569）；息肉样组患者的平均生存期比非息肉样肿瘤患者长14.9个月。息肉样肿瘤的平均大小和最大生长尺寸均小于非息肉样肿瘤。非息肉样肿瘤以癌或肉瘤为主，而息肉样肿瘤大多以肉瘤为主（p = 0.0348）。息肉样癌肉瘤的肌层浸润程度明显较轻（p = 0.0019），淋巴管浸润率显著较低（p = 0.0002），且倾向于表现为早期肿瘤（p = 0.0265）。息肉样肿瘤中的癌性成分倾向于具有纯或近乎纯（≥90%）的子宫内膜样组织学类型（p = 0.1608）。息肉样状态与肉瘤性成分类型之间无关联（p = 0.5299）。
息肉样癌肉瘤在癌肉瘤比例、肌层和淋巴管浸润、分期及癌性成分类型等关键组织学参数方面与其非息肉样对应物不同。息肉样肿瘤患者的生存结局可能优于非息肉样肿瘤患者。
