*Department of Oncology-Pathology, Karolinska Institutet †Department of Pathology and Cytology, Karolinska University Hospital, Stockholm §Department of Pathology, Skåne University Hospital, Lund ¶StatSoft Scandinavia AB, Uppsala, Sweden Departments of ‡Gynecologic Oncology #Pathology, Norwegian Radium Hospital, Oslo University Hospital **Institute for Clinical Medicine, the Medical Faculty, University of Oslo, Oslo, Norway ∥Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Am J Surg Pathol. 2017 Sep;41(9):1231-1237. doi: 10.1097/PAS.0000000000000894.
Undifferentiated uterine sarcomas (UUS) are a heterogenous group of high-grade mesenchymal tumors. Although these tumors are highly aggressive, a subset of patients may experience long-term survival. These tumors have previously been divided morphologically into uniform and pleomorphic types. A previous study demonstrated that a mitotic index cutoff of 25 mitoses/10 high-power fields (corresponding to 11.16 mitotic figures/mm) could successfully divide tumors into 2 prognostic groups with significantly different overall survival. The goals of the current study were to (1) validate this mitotic index cutoff in an independent, multicenter cohort and (2) explore the prognostic value of the mitotic index groups in relation to other clinicopathologic variables. Cases were included from 3 independent institutions: The Norwegian Radium Hospital, The Mayo Clinic, and Skåne University Hospital. A total of 40 tumors were included after central review. All cases were negative for the YWHAE-FAM22A/B and JAZF1-JJAZ1 translocations. Survival data were available on all patients. In this study, one-third of patients with UUS survived beyond 5 years. The crude (unadjusted) Cox Proportional Hazards model revealed a number of parameters that significantly impacted overall survival, including mitotic index group, patient age, stage, and the presence of tumor necrosis. Classification into the uniform and pleomorphic types was not prognostic. Combining these parameters into an adjusted model revealed that only the mitotic index group and stage were prognostic. On the basis of these findings, it is proposed that UUS be subdivided into "mitogenic" and "not otherwise specified" types.
未分化子宫肉瘤（UUS）是一组高度恶性的间叶性肿瘤。尽管这些肿瘤具有高度侵袭性，但一部分患者可能会长期生存。这些肿瘤以前在形态上分为均匀型和多形性。先前的一项研究表明，有丝分裂指数截断值为 25 个有丝分裂/10 个高倍视野（相当于 11.16 个有丝分裂图/平方毫米）可以成功地将肿瘤分为 2 个具有显著不同总体生存率的预后组。本研究的目的是：（1）在独立的多中心队列中验证该有丝分裂指数截断值；（2）探讨有丝分裂指数组与其他临床病理变量的关系及其预后价值。病例来自 3 个独立机构：挪威镭医院、梅奥诊所和斯科讷大学医院。经中心审查后共纳入 40 例肿瘤。所有病例均为 YWHAE-FAM22A/B 和 JAZF1-JJAZ1 易位阴性。所有患者均有生存数据。在这项研究中，三分之一的 UUS 患者存活时间超过 5 年。未经调整的 Cox 比例风险模型显示了许多显著影响总生存率的参数，包括有丝分裂指数组、患者年龄、分期和肿瘤坏死的存在。将肿瘤分为均匀型和多形性并不具有预后价值。将这些参数纳入调整后的模型中显示，只有有丝分裂指数组和分期具有预后价值。基于这些发现，建议将 UUS 进一步分为“有丝分裂原性”和“非特指”类型。
