Carroll Amy, Ramirez Pedro T, Westin Shannon N, Soliman Pamela T, Munsell Mark F, Nick Alpa M, Schmeler Kathleen M, Klopp Ann H, Fleming Nicole D
Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Gynecol Oncol. 2014 Dec;135(3):455-61. doi: 10.1016/j.ygyno.2014.10.022. Epub 2014 Oct 28.
Uterine adenosarcoma is a rare malignancy with little data on optimal management. We aimed to clarify the impact of adjuvant therapy in patients with uterine adenosarcoma and identify risk factors for recurrence and death.
We performed a retrospective review of patients undergoing primary evaluation and treatment for uterine adenosarcoma at a single institution from July 1982 through December 2011. Univariate and multivariate analyses were used to identify prognostic factors for progression-free survival (PFS) and overall survival (OS).
We identified 100 patients with uterine adenosarcoma, and 74 patients met the inclusion criteria. On multivariate analysis, sarcomatous overgrowth (SO) and lymphovascular space invasion (LVSI) were predictors of worse PFS and OS. Median PFS and OS were 29.4 and 55.4 months for patients with SO, compared to 105.9 and 112.4 months for patients without SO (PFS HR 2.58, 95% CI 1.37-4.84, p=0.003; OS HR 2.45, 95% CI 1.26-4.76, p=0.008). Among patients with stage I disease, 17 of 22 patients (77%) with SO and 8 of 37 patients (22%) without SO had a recurrence (p<0.001). Among patients with stage I disease with SO, adjuvant therapy appeared to be associated with longer PFS and OS, but these differences were not statistically significant (PFS, 46.7 vs. 29.4 months, p=0.28; OS, 97.3 vs. 55.4 months, p=0.18).
In patients with uterine adenosarcoma, the presence of SO or LVSI confers a higher risk of recurrence. We did not identify an optimal treatment strategy for patients with SO, but adjuvant therapy may be associated with prolonged PFS.
子宫腺肉瘤是一种罕见的恶性肿瘤，关于其最佳治疗方案的数据较少。我们旨在阐明辅助治疗对子宫腺肉瘤患者的影响，并确定复发和死亡的危险因素。
我们对1982年7月至2011年12月在单一机构接受子宫腺肉瘤初次评估和治疗的患者进行了回顾性研究。采用单因素和多因素分析来确定无进展生存期（PFS）和总生存期（OS）的预后因素。
我们确定了100例子宫腺肉瘤患者，其中74例符合纳入标准。多因素分析显示，肉瘤样过度生长（SO）和脉管间隙浸润（LVSI）是PFS和OS较差的预测因素。有SO的患者中位PFS和OS分别为29.4个月和55.4个月，而无SO的患者分别为105.9个月和112.4个月（PFS风险比2.58，95%置信区间1.37 - 4.84，p = 0.003；OS风险比2.45，95%置信区间1.26 - 4.76，p = 0.008）。在Ⅰ期疾病患者中，22例有SO的患者中有17例（77%）复发，37例无SO的患者中有8例（22%）复发（p < 0.001）。在Ⅰ期有SO的疾病患者中，辅助治疗似乎与更长的PFS和OS相关，但这些差异无统计学意义（PFS，46.7个月对29.4个月，p = 0.28；OS，97.3个月对55.4个月，p = 0.18）。
在子宫腺肉瘤患者中，存在SO或LVSI会增加复发风险。我们未确定针对有SO患者的最佳治疗策略，但辅助治疗可能与延长PFS相关。
