子宫平滑肌肉瘤：最新系列报道。

Uterine leiomyosarcoma: an updated series.

机构信息

Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

出版信息

Int J Gynecol Cancer. 2013 Jul;23(6):1036-43. doi: 10.1097/IGC.0b013e31829590dc.

DOI:10.1097/IGC.0b013e31829590dc

PMID:23714705

Abstract

OBJECTIVE

The aim of this study was to analyze and compare the clinicopathologic characteristics, treatment, and survival in patients with uterine leiomyosarcoma (ULMS) during the last 10 years in 3 referral academic centers.

METHODS

All patients with ULMS who underwent treatment at the participating institutions between January 1, 2000, and December 31, 2010, were identified from the tumor registry database. In each case, the diagnosis was confirmed by a dedicated gynecologic pathologist following postsurgery pathology review. The Kaplan-Meier method was used to generate overall survival (OS) data. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis.

RESULTS

Analysis of 167 women with ULMS with adequate follow-up was performed. One hundred twenty-eight patients (77%) were initially managed at the participating institutions, and 39 (23%) were referred after initial management at a different institution. Ninety-two (55%) had stage I disease, 7 (4%) had stage II, 18 (11%) stage III, and 50 (30%) had stage IV disease. The median OS for women with stage I was 75 months, for stage II 66 months, stage III 34 months, and stage IV 20 months (P < 0.001). For patients with early stage (I and II), race, lower grade, smaller tumor size (<11 cm), low number of mitosis (<25/10 high-power field [HPF]), lymphovascular space invasion, and presence of necrosis were identified as variables with prognostic influence on survival in the univariate analysis. A Cox proportional hazards model identified size 11 cm or greater (hazard ratio, 5.9; P < 0.001) and mitotic count of 25/10 HPF or greater (hazard ratio, 2.3; P = 0.05) as independent predictors of OS. For patients with late stage (stage III and IV), race, stage III versus IV, lower grade, smaller tumor size (<11 cm), and low number of mitosis (<25/10 HPF) were all associated with significantly improved OS. A Cox proportional hazards model identified mitotic count of 25/10 HPF or greater (P = 0.01) as independent predictor of OS.

CONCLUSIONS

In early stage, size of the tumor and number of mitosis were associated to survival. In contrast to late stage, only mitotic count was associated to survival.

摘要

目的

本研究旨在分析比较 3 家转诊学术中心过去 10 年中子宫内膜间质肉瘤（ULMS）患者的临床病理特征、治疗方法和生存情况。

方法

从肿瘤登记数据库中确定了 2000 年 1 月 1 日至 2010 年 12 月 31 日期间在参与机构接受治疗的所有 ULMS 患者。每位患者的诊断均通过专门的妇科病理学家在术后病理复查后得到确认。采用 Kaplan-Meier 法生成总生存（OS）数据。使用对数秩检验和 Cox 回归分析比较预测结局的因素。

结果

对 167 例有足够随访的 ULMS 女性进行了分析。128 例（77%）患者最初在参与机构接受治疗，39 例（23%）在不同机构接受初始治疗后转诊。92 例（55%）为Ⅰ期疾病，7 例（4%）为Ⅱ期，18 例（11%）为Ⅲ期，50 例（30%）为Ⅳ期。Ⅰ期女性的中位 OS 为 75 个月，Ⅱ期为 66 个月，Ⅲ期为 34 个月，Ⅳ期为 20 个月（P < 0.001）。对于早期（Ⅰ和Ⅱ期）患者，种族、较低的分级、肿瘤较小（<11cm）、低有丝分裂计数（<25/10 高倍视野[HPF]）、脉管间隙浸润和存在坏死被确定为单变量分析中对生存有预后影响的变量。Cox 比例风险模型确定了肿瘤大小为 11cm 或更大（风险比，5.9；P < 0.001）和有丝分裂计数为 25/10 HPF 或更大（风险比，2.3；P = 0.05）是 OS 的独立预测因子。对于晚期（Ⅲ期和Ⅳ期）患者，种族、Ⅲ期与Ⅳ期、较低的分级、肿瘤较小（<11cm）和低有丝分裂计数（<25/10 HPF）均与显著改善的 OS 相关。Cox 比例风险模型确定了有丝分裂计数为 25/10 HPF 或更高（P = 0.01）是 OS 的独立预测因子。