Garcia Christine, Kubat Jenna S, Fulton Regan S, Anthony Adam T, Combs Mary, Powell C Bethan, Littell Ramey D
*Division of Gynecologic Oncology, and †Department of Pathology, The Permanente Medical Group, San Francisco, CA; and ‡Division of Biostatistics, University of California, Berkeley, CA.
Int J Gynecol Cancer. 2015 May;25(4):622-8. doi: 10.1097/IGC.0000000000000370.
The aim was to identify clinical parameters and immunohistochemical markers predictive of recurrence and overall survival (OS) in a community cohort of patients with primary uterine leiomyosarcoma (ULMS).
METHODS/MATERIALS: All patients with new diagnosis of ULMS from 1999 to 2007 were identified from the Kaiser Permanente Northern California pathology database. A retrospective chart review was performed to gather demographic and clinical data. The primary outcomes were recurrence-free survival and OS. In addition, a subset of tumor samples was available to analyze 3 immunohistochemical markers using tissue microarray techniques; these are as follows: estrogen receptor (ER) alpha, epidermal growth factor receptor (EGFR), and Ki-67.
Seventy-five patients with ULMS were identified, of which 63 had adequate tumor tissue available for immunohistochemical evaluation. The median follow-up for all stages was 28 months. The rate of recurrence or progressive disease was 76% for stage I patients compared with 85% for stage II to IV patients. At 3 years, 37% of stage I patients were recurrence free compared with 27% of stage II to IV patients. Overall survival for stage I patients declined from 64% to 38% between 3 and 5 years while remaining stable at 30% for stage II to IV patients. In multivariable analysis, increasing mitotic counts were associated with increased risk of recurrence (hazards ratio [HR], 3.2; P = 0.013) and a trend toward decreased OS (HR, 2.2; P = 0.10). Expression of ER (HR, 1.0), EGFR expression (HR, 1.0), and Ki-67 expression (HR, 1.0) were not predictive of recurrence or OS.
Recurrence rate of 76% for patients with stage I ULMS was higher than previously published cohorts. Mitotic counts were associated with increased recurrence and decreased OS. Expressions of ER, EGFR, and Ki-67 were not useful for predicting overall recurrence or survival.
旨在确定原发性子宫平滑肌肉瘤（ULMS）患者社区队列中预测复发和总生存期（OS）的临床参数及免疫组化标志物。
方法/材料：从北加利福尼亚凯撒医疗集团病理数据库中识别出1999年至2007年所有新诊断为ULMS的患者。进行回顾性病历审查以收集人口统计学和临床数据。主要结局为无复发生存期和总生存期。此外，利用组织芯片技术对一部分肿瘤样本进行分析，以检测三种免疫组化标志物，具体如下：雌激素受体（ER）α、表皮生长因子受体（EGFR）和Ki-67。
共识别出75例ULMS患者，其中63例有足够的肿瘤组织可用于免疫组化评估。所有分期患者的中位随访时间为28个月。I期患者的复发或疾病进展率为76%，而II至IV期患者为85%。3年时，I期患者37%无复发，II至IV期患者为27%。I期患者的总生存期在3至5年间从64%降至38%，而II至IV期患者则稳定在30%。多变量分析显示，有丝分裂计数增加与复发风险增加相关（风险比[HR]，3.2；P = 0.013），且有总生存期降低的趋势（HR，2.2；P = 0.10）。ER表达（HR，1.0）、EGFR表达（HR，1.0）和Ki-67表达（HR，1.0）均不能预测复发或总生存期。
I期ULMS患者76%的复发率高于先前发表的队列。有丝分裂计数与复发增加和总生存期降低相关。ER、EGFR和Ki-67的表达对预测总体复发或生存期并无帮助。
