6/F, Professorial Block, Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong.
Best Pract Res Clin Obstet Gynaecol. 2011 Dec;25(6):733-49. doi: 10.1016/j.bpobgyn.2011.05.011. Epub 2011 Jul 14.
Uterine sarcomas comprise leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, undifferentiated endometrial sarcoma, and their variants. Carcinosarcoma is historically classified as sarcoma, but it is now regarded as a metaplastic carcinoma. Uterine sarcomas are rare, and are traditionally staged in the same way as endometrial carcinoma. Because of their different clinical and biological behaviours, the International Federation of Gynecology and Obstetrics introduced a new staging system in 2009 for leiomyosarcoma, endometrial stromal sarcoma and adenosarcoma, and carcinosarcoma, respectively. Following an extensive literature review no good evidence was found to support the modification of the staging system. This is mainly because of the rarity of the sarcomas and the heterogeneity of the reports, the different diagnostic criteria and treatments changing over the decades the retrospective nature and small sample size in most studies, and the lack of uniform pathological review even in large studies. Currently, evidence is still lacking about the use of preoperative imaging for staging purpose, and uterine sarcomas remain to be surgically staged. Total hysterectomy is the cornerstone for both staging and treatment. Newer evidence shows that routine lymphadenectomy and bilateral salpingo-oophorectomy may not be necessary, unless in the presence of extra-uterine spread, suspicious ovaries or lymph nodes, and certain poor histological types, such as undifferentiated endometrial sarcoma and adenosarcoma with sarcomatous overgrowth. More research and data collection are definitely needed in order to verify and further revise the current staging systems.
子宫肉瘤包括平滑肌肉瘤、子宫内膜间质肉瘤、腺肉瘤、未分化子宫内膜肉瘤及其变体。癌肉瘤在历史上被归类为肉瘤，但现在被认为是一种化生癌。子宫肉瘤很少见，传统上的分期方式与子宫内膜癌相同。由于它们具有不同的临床和生物学行为，国际妇产科联合会于 2009 年分别为平滑肌肉瘤、子宫内膜间质肉瘤和腺肉瘤以及癌肉瘤引入了新的分期系统。在广泛的文献回顾后，没有发现足够的证据支持对分期系统进行修改。这主要是因为肉瘤的罕见性和报告的异质性、几十年来不同的诊断标准和治疗方法、大多数研究的回顾性和样本量小以及即使在大型研究中也缺乏统一的病理审查。目前，关于术前影像学用于分期目的的证据仍然不足，子宫肉瘤仍需手术分期。全子宫切除术是分期和治疗的基石。新的证据表明，除非存在子宫外扩散、可疑的卵巢或淋巴结，以及某些组织学类型较差，如未分化子宫内膜肉瘤和腺肉瘤伴肉瘤过度生长，否则常规淋巴结切除术和双侧输卵管卵巢切除术可能不是必需的。为了验证和进一步修订现有的分期系统，肯定需要更多的研究和数据收集。
