Dizon Don S, Birrer Michael J
Gillette Center of Gynecologic Oncology, Massachusetts General, Harvard Medical School, Boston, MA 02114, USA.
Discov Med. 2014 Jun;17(96):339-45.
Uterine sarcomas account for less than 10% of all uterine neoplasms (Tropé et al., 2012). The most common include uterine leiomyosarcoma and the endometrial stromal neoplasms. The diagnosis requires pathologic review of the uterus in order to characterize extent of myometrial invasion. However, molecular diagnosis has aided the classification of endometrial stromal neoplasms, especially in helping to discriminate between endometrial stromal and undifferentiated endometrial sarcoma. The prognosis of these tumors following surgery varies, with endometrial stromal sarcoma associated with a better prognosis compared to leiomyosarcoma or undifferentiated endometrial sarcoma. For aggressive sarcomas, there is interest in adjuvant treatment, which has focused on the evaluation of systemic agents. However, the rarity of these tumors makes the conduct of prospective trials difficult and no consensus adjuvant regimen has emerged. In the absence of Level I data, the use of chemotherapy is based on institutional preferences. Ongoing clinical trials will help inform the standard treatment approach for these tumors, and we encourage patients with uterine sarcoma to participate in well-designed clinical trials.
子宫肉瘤占所有子宫肿瘤的比例不到10%（特罗佩等人，2012年）。最常见的包括子宫平滑肌肉瘤和子宫内膜间质肿瘤。诊断需要对子宫进行病理检查，以确定肌层浸润的程度。然而，分子诊断有助于子宫内膜间质肿瘤的分类，特别是有助于区分子宫内膜间质肉瘤和未分化子宫内膜肉瘤。这些肿瘤手术后的预后各不相同，与平滑肌肉瘤或未分化子宫内膜肉瘤相比，子宫内膜间质肉瘤的预后较好。对于侵袭性肉瘤，人们对辅助治疗很感兴趣，辅助治疗主要集中在评估全身用药。然而，这些肿瘤非常罕见，使得开展前瞻性试验很困难，目前尚未形成共识的辅助治疗方案。在缺乏一级数据的情况下，化疗的使用基于机构的偏好。正在进行的临床试验将有助于明确这些肿瘤的标准治疗方法，我们鼓励子宫肉瘤患者参加精心设计的临床试验。
