Women's Cancer Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2008 Mar;40(1):6-10. doi: 10.4143/crt.2008.40.1.6. Epub 2008 Mar 31.
The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESSs) in relation to their clinical and pathogenic features, and to determine the optimal treatment strategy.
A retrospective analysis was performed involving 28 patients with histologic-proven ESSs treated at our institution between 1987 and 2006.
The median follow-up was 54.7+/-63.1 months and the 5-year survival rate was 82.0%. Twenty-two (81.5%) and 5 patients (18.5%) had low- and high-grade disease, respectively. Univariate analysis revealed that the histologic grades, based on mitotic count, were associated with longer survival (p=0.004). However, among those patients with low-grade tumors, 5/20 patients (25%) had a recurrence and 2/21 patients (9.5%) had distant metastasis during the follow-up period. With the exception of 2 patients, 26 patients with ESSs underwent hysterectomy as primary treatment. Adjuvant treatment after surgery was administered to 14/26 patients (53.8%). Hormone therapy with progesterone, chemotherapy, and/or radiotherapy did not influence overall survival. However, the postoperative adjuvant therapy group, regardless of the treatment modality, was associated with relatively increased overall survival when compared to the surgery only group (p=0.054).
The preoperative differential diagnosis of ESSs from other benign gynecologic diseases is often difficult. We recommend adjuvant therapy be administered after hysterectomy in patients with ESS to prevent recurrence or distant metastasis.
本研究旨在评估子宫内膜间质肉瘤（ESS）的临床和病理特征，并确定最佳治疗策略。
回顾性分析了 1987 年至 2006 年间在我院治疗的 28 例经组织学证实的 ESS 患者。
中位随访时间为 54.7+/-63.1 个月，5 年生存率为 82.0%。22 例（81.5%）和 5 例（18.5%）患者的疾病分级分别为低级别和高级别。单因素分析显示，基于有丝分裂计数的组织学分级与生存时间延长相关（p=0.004）。然而，在低级别肿瘤患者中，有 5/20 例（25%）复发，2/21 例（9.5%）发生远处转移。除 2 例患者外，26 例 ESS 患者行子宫切除术作为初始治疗。术后有 14/26 例（53.8%）患者接受辅助治疗。孕激素为主的激素治疗、化疗和/或放疗对总生存无影响。然而，与仅手术组相比，术后辅助治疗组（无论治疗方式如何）的总生存率均有所提高（p=0.054）。
ESS 与其他良性妇科疾病的术前鉴别诊断通常较为困难。我们建议对 ESS 患者行子宫切除术辅助治疗，以预防复发或远处转移。
