Massachusetts General Hospital, Boston, MA, USA.
Am J Surg Pathol. 2011 Apr;35(4):522-9. doi: 10.1097/PAS.0b013e31820ca624.
Uterine leiomyosarcomas (Ut-LMSs) are aggressive tumors with an overall poor prognosis (15% to 25% 5-year survival rate). However, patients with stage I Ut-LMSs are reported to have a relatively better outcome when compared with the overall group with a 5-year survival rate ranging from 25% to 75%. The purpose of this study was to evaluate the histopathologic parameters that may impact outcome in stage I Ut-LMSs. Twenty-seven patients with stage I Ut-LMSs were identified from the files of 5 tertiary care hospitals between 1974 and 2006. Tumors were primarily staged based on pathologic information, supplemented with radiologic findings (10 cases) and clinical records (1 case). Patients with stage I tumors with no additional clinical or radiologic staging information were included in the study if no recurrence was documented after 6 months from the initial staging operation (16 cases). Clinicopathologic parameters that were statistically evaluated included age [mean, 54 y (37 to 73)], tumor size [mean, 9.5 cm (5.5 to 16)], cell type (17 spindled, 5 epithelioid, 2 myxoid, and 3 mixed), mitotic activity [mean count, 24 (4 to 69)/10 high-power fields], marked cytologic atypia (26 of 27 cases), tumor cell necrosis (12 of 27 cases), and lymphovascular invasion (6 of 27 cases). Follow-up was available for all the patients. Poor outcome was defined when patients either died of disease or were alive with disease. Overall, accounting for any length of follow-up, 16 of 27 (59%) patients with stage I Ut-LMSs had poor outcome; 7 died of disease (mean follow-up, 13 mo) and 9 were alive with disease (mean follow-up, 31 mo). The remaining 11 patients were alive and well with a mean follow-up of 48 months. However, at 2 years of follow-up by univariate analysis, only nonspindle morphology (P<0.0183) and diffuse high-grade cytologic atypia (P<0.02) were statistically associated with poor outcome. No statistically significant association with survival was identified by univariate analysis when evaluating mean age, mean tumor size, presence of tumor cell necrosis, mean mitotic count, or lymphovascular invasion. In conclusion, stage I leiomyosarcoma is associated with poor prognosis. No conclusive differences were observed among different clinicopathologic parameters and prognosis, although it seemed that spindle cell morphology and diffuse high-grade cytologic atypia were associated with longer overall survival and higher death rates, respectively.
子宫平滑肌肉瘤（Ut-LMSs）是一种侵袭性肿瘤，总体预后较差（5 年生存率为 15%-25%）。然而，与总体人群相比，Ⅰ期 Ut-LMSs 患者的预后相对较好，5 年生存率为 25%-75%。本研究旨在评估可能影响Ⅰ期 Ut-LMSs 患者预后的组织病理学参数。从 1974 年至 2006 年 5 家三级保健医院的档案中确定了 27 例Ⅰ期 Ut-LMSs 患者。肿瘤主要根据病理信息进行分期，辅以影像学发现（10 例）和临床记录（1 例）。如果在初始分期手术后 6 个月内无复发记录，则将Ⅰ期肿瘤且无其他临床或影像学分期信息的患者纳入研究（16 例）。统计学评估的临床病理参数包括年龄[平均 54 岁（37-73 岁）]、肿瘤大小[平均 9.5cm（5.5-16cm）]、细胞类型（17 例梭形、5 例上皮样、2 例黏液样、3 例混合性）、有丝分裂活性[平均计数 24（4-69）/10 高倍视野]、明显的细胞异型性（27 例中的 26 例）、肿瘤细胞坏死（27 例中的 12 例）和血管淋巴管浸润（27 例中的 6 例）。所有患者均获得随访。当患者死于疾病或患有疾病但仍存活时，定义为预后不良。总体而言，无论随访时间长短，27 例Ⅰ期 Ut-LMSs 患者中有 16 例（59%）预后不良；7 例死于疾病（平均随访 13 个月），9 例患有疾病但仍存活（平均随访 31 个月）。其余 11 例患者情况良好，平均随访 48 个月。然而，通过单因素分析，只有非梭形形态（P<0.0183）和弥漫性高级别细胞异型性（P<0.02）与不良预后具有统计学相关性。通过单因素分析评估平均年龄、平均肿瘤大小、肿瘤细胞坏死、平均有丝分裂计数或血管淋巴管浸润时，与生存无统计学显著相关性。总之，Ⅰ期平滑肌肉瘤与不良预后相关。虽然梭形细胞形态和弥漫性高级别细胞异型性似乎分别与更长的总生存期和更高的死亡率相关，但不同的临床病理参数与预后之间未观察到明确的差异。
