Foley Olivia W, Rauh-Hain J Alejandro, Clemmer Joel, Clark Rachel M, Hall Tracilyn, Diver Elisabeth J, Schorge John O, del Carmen Marcela G
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Int J Gynecol Cancer. 2015 Mar;25(3):453-8. doi: 10.1097/IGC.0000000000000372.
Uterine leiomyosarcoma (LMS) is a relatively rare malignancy that is associated with a poor prognosis. The rarity of LMS has led to a lack of consensus regarding appropriate treatment. The goal of this study was to identify the role that chemotherapy and radiotherapy have played in the treatment of uterine LMS in the United States as well as the effectiveness of adjuvant treatment.
MATERIALS/METHODS: We used the SEER (Surveillance, Epidemiology, and End Results)-Medicare database to gather information on uterine LMS patients older than the age of 66 years diagnosed between 1992 and 2009. Basic demographic and clinical characteristics were collected. A logistic regression model analysis was performed to determine predictors of treatment. Cox proportional hazards models were used to identify clinical parameters and treatment strategies associated with survival differences.
Our final study group included 230 patients. We found that the rate of use of chemotherapy and radiotherapy in the treatment of patients with uterine LMS increased over the period investigated. However, we identified no significant survival advantage associated with either mode of therapy. The strongest predictor of survival was stage at diagnosis. The logistic regression model analysis revealed that age at diagnosis, treatment year, stage, and underlying health status were all independent predictors of chemotherapy. Age at diagnosis was also a predictor of radiation therapy.
The increasing rates of chemotherapy and radiotherapy use in this population seem to be unfounded given the lack of survival benefit. Further investigation into alternative treatment regimens is merited. The prognostic significance of stage at diagnosis indicates the importance of improving early detection of uterine LMS.
子宫平滑肌肉瘤（LMS）是一种相对罕见的恶性肿瘤，预后较差。LMS的罕见性导致在适当治疗方面缺乏共识。本研究的目的是确定化疗和放疗在美国子宫LMS治疗中所起的作用以及辅助治疗的有效性。
材料/方法：我们使用监测、流行病学和最终结果（SEER）-医疗保险数据库收集1992年至2009年间诊断出的66岁以上子宫LMS患者的信息。收集基本人口统计学和临床特征。进行逻辑回归模型分析以确定治疗的预测因素。使用Cox比例风险模型来识别与生存差异相关的临床参数和治疗策略。
我们的最终研究组包括230名患者。我们发现，在研究期间，子宫LMS患者治疗中化疗和放疗的使用率有所增加。然而，我们未发现任何一种治疗方式具有显著的生存优势。生存的最强预测因素是诊断时的分期。逻辑回归模型分析显示，诊断时的年龄、治疗年份、分期和基础健康状况都是化疗的独立预测因素。诊断时的年龄也是放疗的预测因素。
鉴于缺乏生存获益，该人群中化疗和放疗使用率的增加似乎没有依据。值得对替代治疗方案进行进一步研究。诊断时分期的预后意义表明改善子宫LMS早期检测的重要性。
