Mihailovici Anca, Rottenstreich Misgav, Kovel Svetlana, Wassermann Ilan, Smorgick Noam, Vaknin Zvi
Departments of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated to the Hebrew University School of Medicine, Jerusalem Medical Oncology General Surgery, Assaf-Harofeh Medical Center, Zerifin, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Medicine (Baltimore). 2017 Dec;96(49):e9136. doi: 10.1097/MD.0000000000009136.
Endometriosis-associated malignant transformation in abdominal surgical scar (EAMTAS) is a very rare and aggressive phenomenon. Our current article aims to provide a clinical overview, focusing on risk factors affecting survival.
We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review based on prior reviews and case reports regarding the phenomenon published as abstracts in English, from January 1980 to November 2016. Overall, we identified 47 cases, and we included another case from our institution. We further contacted previous investigators to receive updated follow-up regarding their patients. We analyzed the data, focusing on risk factors that might affect overall survival.
All the patients reported in the literature had a uterine surgery, mainly caesarean section. The median time-lag from first surgery to the diagnosis of cancer was about 19 years. Clear-cell carcinoma (CCC) was the most prevalent histology (67%), followed by endometrioid adenocarcinoma (15%). Most of the patients were treated by extensive surgery and chemotherapy and/or radiation. Overall 5 years survival was about 40%. Median overall survival was 42 months (95% confidence interval of [18.7, 65.3]). Although our review is currently the largest in the literature, we cannot draw any statistical significant results due to the limited number of patients reported. According to univariate Cox-regression models, a tendency toward worse prognosis was shown for 3-year disease-free survival clear cell histologic-type (P = .169), and tumor diameter ≥8 cm in nonclear-cell histology, 18 months postdiagnosis (P = .06).
EAMTAS is a rare and aggressive disease. It is mostly related to cesarean section scars and is diagnosed many years postsurgery. Clear-cell histology tends to endure from the worse prognosis. The treatment is mainly extensive surgery and adjuvant chemotherapy and/or radiotherapy.
腹壁手术瘢痕内异症相关的恶性转化（EAMTAS）是一种非常罕见且侵袭性强的现象。我们当前的文章旨在提供临床概述，重点关注影响生存的危险因素。
我们基于1980年1月至2016年11月期间以英文摘要形式发表的关于该现象的既往综述和病例报告，进行了一项符合系统评价和Meta分析的首选报告项目规范的系统评价。总体而言，我们识别出47例病例，并纳入了我们机构的另一例病例。我们进一步联系了之前的研究者以获取其患者的最新随访情况。我们分析了数据，重点关注可能影响总生存的危险因素。
文献报道的所有患者均接受过子宫手术，主要是剖宫产。从首次手术到癌症诊断的中位时间间隔约为19年。透明细胞癌（CCC）是最常见的组织学类型（67%），其次是子宫内膜样腺癌（15%）。大多数患者接受了广泛手术及化疗和/或放疗。总体5年生存率约为40%。中位总生存时间为42个月（95%置信区间为[18.7, 65.3]）。尽管我们的综述目前是文献中规模最大的，但由于报告的患者数量有限，我们无法得出任何具有统计学意义的结果。根据单变量Cox回归模型，透明细胞组织学类型的3年无病生存显示出预后较差的趋势（P = 0.169），非透明细胞组织学中肿瘤直径≥8 cm且诊断后18个月时也显示出该趋势（P = 0.06）。
EAMTAS是一种罕见且侵袭性强的疾病。它主要与剖宫产瘢痕相关，且在手术后多年被诊断出来。透明细胞组织学类型往往预后较差。治疗主要是广泛手术及辅助化疗和/或放疗。
