Zhang Chuyao, Hu Weiguo, Jia Nan, Li Qing, Hua Keqin, Tao Xiang, Wang Li, Feng Weiwei
*Department of Gynecology, Obstetrics and Gynecology Hospital, †Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, and ‡Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Int J Gynecol Cancer. 2015 May;25(4):629-36. doi: 10.1097/IGC.0000000000000350.
This retrospective study aimed to evaluate the clinicopathological characteristics of carcinosarcoma, grade 3 endometrial endometrioid carcinoma (G3EEC), uterine serous carcinoma (USC), and uterine clear cell adenocarcinoma (CC) to determine whether carcinosarcoma exhibited the same characteristics and outcomes as the other 3 high-risk endometrial cancers.
A total of 358 patients recruited from the Obstetrics and Gynecology Hospital of Fudan University were included in this study; the cases included 44 carcinosarcomas, 118 G3EECs, 118 USCs, and 78 CCs. Kaplan-Meier and Cox proportional hazards models were used to analyze outcomes and prognostic factors.
Uterine carcinosarcomas had significantly worse outcomes (overall survival, disease-specific survival, and recurrence-free survival) compared with G3EEC, USC, and CC (P < 0.001), whereas the other 3 shared similar outcomes. Carcinosarcoma type was an independent factor, even stratified by stage. Eighty-three percent of recurred carcinosarcoma patients occurred within 1 year. Compared with USC and CC, patients with carcinosarcoma had a greater incidence of deep myometrial invasion (55.8%, P < 0.05) and cervical stromal involvement (P = 0.046). The carcinomatous regions of carcinosarcomas demonstrated a similar ER/P53 expression pattern as did USC and CC. However, all features were similar in carcinosarcoma and G3EEC patients, although the P53-positive rate was higher in carcinosarcoma patients compared with G3EEC patients (59.0% vs 38.5%, P = 0.037). For carcinosarcomas, a multivariate analysis showed that advanced stage (P = 0.006) was an independent prognostic factor for disease-specific survival. With regard to endometrioid-or-not epithelial and heterologous-or-homologous sarcomatous components, none of these components demonstrated apparent relationship with prognosis.
Carcinosarcomas exhibited significantly poorer outcomes than did G3EECs, USCs, and CCs. Therefore, it seems reasonable to regard carcinosarcomas as a particular type among high-risk epithelial endometrial carcinomas.
本回顾性研究旨在评估癌肉瘤、3级子宫内膜样腺癌（G3EEC）、子宫浆液性癌（USC）及子宫透明细胞腺癌（CC）的临床病理特征，以确定癌肉瘤是否与其他3种高危子宫内膜癌具有相同的特征和预后。
本研究纳入了复旦大学附属妇产科医院招募的358例患者；病例包括44例癌肉瘤、118例G3EEC、118例USC和78例CC。采用Kaplan-Meier法和Cox比例风险模型分析预后及预后因素。
与G3EEC、USC和CC相比，子宫癌肉瘤的预后（总生存期、疾病特异性生存期和无复发生存期）明显更差（P<0.001），而其他3种癌症的预后相似。癌肉瘤类型是一个独立因素，即使按分期分层也是如此。83%的癌肉瘤复发患者在1年内复发。与USC和CC相比，癌肉瘤患者肌层浸润深度更大（55.8%，P<0.05）和宫颈间质受累发生率更高（P=0.046）。癌肉瘤的癌性区域显示出与USC和CC相似的雌激素受体/ P53表达模式。然而，癌肉瘤和G3EEC患者的所有特征相似，尽管癌肉瘤患者的P53阳性率高于G3EEC患者（59.0%对38.5%，P=0.037）。对于癌肉瘤，多因素分析显示晚期（P=0.006）是疾病特异性生存的独立预后因素。关于是否为子宫内膜样上皮及异源性或同源性肉瘤成分，这些成分均未显示与预后有明显关系。
癌肉瘤的预后明显比G3EEC、USC和CC差。因此，将癌肉瘤视为高危子宫内膜上皮癌中的一种特殊类型似乎是合理的。
