Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Obstet Gynecol. 2013 Sep;122(3):676-83. doi: 10.1097/AOG.0b013e3182a189ac.
To summarize available studies with respect to evaluation and management of patients with endometrial stromal sarcoma and undifferentiated endometrial sarcoma.
We conducted an electronic search of research articles published in English between January 1, 1981, and January 1, 2013, using MEDLINE, PubMed, and ClinicalTrials.gov (www.clinicaltrials.gov) databases.
Of the 115 studies initially identified, 86 were chosen after limiting the review to those articles focusing on endometrial stromal sarcoma and crossreferencing to eliminate duplication. Review articles were excluded. Of the 86 studies meeting eligibility criteria, 84 were retrospective, one was a prospective phase II trial, and one was a phase III randomized study. Data were extracted systematically. Each of the reviewers assessed the quality of each study independently.
TABULATION, INTEGRATION, AND RESULTS: Data were abstracted using standard abstraction templates to summarize study findings. Given the rarity of this tumor, we report available data with respect to epidemiology, pathogenesis, prognostic factors, and treatment. Endometrial stromal sarcoma and undifferentiated endometrial sarcoma comprise an estimated 1% of all uterine cancers and less than 10% of all uterine mesenchymal neoplasms. Hysterectomy and bilateral salpingo-oophorectomy is the cornerstone of treatment for early-stage (I or II) disease. Surgical resection when feasible may also be appropriate for patients presenting with advanced-stage tumors. The value of adjuvant therapy for early-stage disease remains unproven. Hormone therapy continues to be the most efficacious treatment modality for patients with advanced-stage or recurrent disease.
Endometrial stromal sarcoma and undifferentiated endometrial sarcoma are rare tumors. Surgical resection is appropriate for patients with early-stage (I or II) disease and those with resectable, advanced-stage (III or IV) tumors. Hormone therapy may be appropriate in treating advanced and recurrent disease.
总结子宫内膜间质肉瘤和未分化子宫内膜肉瘤患者评估和管理的相关研究。
我们对 1981 年 1 月 1 日至 2013 年 1 月 1 日期间以英文发表的研究文章进行了电子检索，检索数据库包括 MEDLINE、PubMed 和 ClinicalTrials.gov（www.clinicaltrials.gov）。
最初确定的 115 项研究中，有 86 项研究在限制综述范围至专门针对子宫内膜间质肉瘤的文章并交叉引用以消除重复的基础上被选中。排除综述文章。在符合入选标准的 86 项研究中，有 84 项为回顾性研究，1 项为前瞻性 II 期试验，1 项为 III 期随机研究。系统地提取数据。两位评审员分别独立评估每项研究的质量。
列表、整合和结果：使用标准提取模板提取数据以总结研究结果。鉴于这种肿瘤的罕见性，我们报告了流行病学、发病机制、预后因素和治疗方面的现有数据。子宫内膜间质肉瘤和未分化子宫内膜肉瘤占所有子宫癌的 1%左右，占所有子宫间叶性肿瘤的不到 10%。子宫切除术和双侧附件切除术是早期（I 期或 II 期）疾病的基石。对于晚期肿瘤患者，可行的外科切除可能也是适当的。早期疾病辅助治疗的价值仍未得到证实。对于晚期或复发性疾病，激素治疗仍是最有效的治疗方式。
子宫内膜间质肉瘤和未分化子宫内膜肉瘤是罕见肿瘤。对于早期（I 期或 II 期）疾病和有可切除的晚期（III 期或 IV 期）肿瘤的患者，手术切除是合适的。激素治疗可能适用于治疗晚期和复发性疾病。
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