Hensley Martee L
From the Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
Am Soc Clin Oncol Educ Book. 2012:356-61. doi: 10.14694/EdBook_AM.2012.32.7.
Uterine sarcomas are rare cancers, they comprise only 5% of all uterine malignancies. There are about 2,000 cases of uterine sarcoma diagnosed annually in the United States. Uterine sarcomas may be categorized as either favorable-risk, low-grade malignancies with a relatively good prognosis or as poor-risk, high-grade cancers that carry a high risk for tumor recurrence and disease progression. Expert histologic review is critical for appropriate diagnosis and management. Uterine sarcoma histologies considered to carry a more favorable prognosis include low-grade endometrial stromal sarcomas and adenosarcomas. The high-grade sarcomas include high-grade leiomyosarcomas, high-grade undifferentiated endometrial sarcomas, and adenosarcomas with sarcomatous overgrowth. The favorable histology, low-grade uterine sarcomas may be cured with surgical resection of uterus-limited disease. These tumors are often hormone-sensitive, and treatment with hormonal therapies may be efficacious for patients with advanced, unresectable disease. High-grade uterine leiomyosarcomas and undifferentiated endometrial sarcomas carry a high risk for recurrence, even after complete resection of uterus-limited disease. No adjuvant intervention has been shown to improve survival outcomes. Advanced, metastatic disease is generally treated with systemic cytotoxic therapies, which may result in objective response but is not curative. Selected patients with isolated metastatic disease and a long disease-free interval may benefit from metastatectomy.
子宫肉瘤是罕见的癌症，仅占所有子宫恶性肿瘤的5%。在美国，每年约有2000例子宫肉瘤被诊断出来。子宫肉瘤可分为预后相对较好的低级别恶性肿瘤，即低风险类型，以及肿瘤复发和疾病进展风险高的高级别癌症，即高风险类型。专业的组织学检查对于正确的诊断和治疗至关重要。预后被认为较好的子宫肉瘤组织学类型包括低级别子宫内膜间质肉瘤和腺肉瘤。高级别肉瘤包括高级别平滑肌肉瘤、高级别未分化子宫内膜肉瘤以及伴有肉瘤样过度生长的腺肉瘤。组织学类型良好的低级别子宫肉瘤通过手术切除局限于子宫的病灶可能治愈。这些肿瘤通常对激素敏感，对于晚期、无法切除的疾病患者，激素治疗可能有效。高级别子宫平滑肌肉瘤和未分化子宫内膜肉瘤即使在完全切除局限于子宫的病灶后仍有很高的复发风险。尚无辅助干预措施被证明能改善生存结果。晚期转移性疾病一般采用全身细胞毒性疗法治疗，这可能会产生客观反应，但无法治愈。部分孤立性转移性疾病且无病间期较长的患者可能从转移灶切除术中获益。
