Barquet-Muñoz Salim Abraham, Isla-Ortiz David, Montalvo-Esquivel Gonzalo, Cantú-de-León David, Salcedo-Hernández Rosa Angélica, Cordoba-Gonzalez Veronica, Herrera-Gómez Ángel
a Department of Gynecologic Oncology , Instituto Nacional de Cancerología , Mexico City , Mexico.
c Department of Clinical Research , Instituto Nacional de Cancerología , Mexico City , Mexico.
J Obstet Gynaecol. 2019 Feb;39(2):231-236. doi: 10.1080/01443615.2018.1492529. Epub 2018 Oct 24.
Uterine sarcomas are infrequent and heterogeneous mesenchymal tumours, associated with aggressive characteristics and a poor clinical outcome. The aim of the study is to describe the prognostic factors associated with uterine sarcomas. The clinical records between 2000 and 2014 of women diagnosed with uterine sarcomas and initially treated surgically were reviewed. A histological comparison was performed. The overall survival (OS) and disease-free survival (DFS) were calculated and compared. Seventy-three women had surgery (12.3% had endometrial stromal sarcomas, 24.7% undifferentiated endometrial sarcomas, 49.3% leiomyosarcomas and 13.7% other subtypes). Complete cytoreduction had a mean DFS of 25.1 months, while the incomplete cytoreduction averaged in a DFS of 4.33 months (p = .04). The median five-year OS with a complete cytoreduction was not reached; the incomplete cytoreduction OS was 10.1 months (p = .002). Our data suggests that undifferentiated endometrial sarcomas have the lowest DFS (p = .004); while OS was negatively influence by stage IV (p < .001). Impact statement What is already known about this subject? Uterine sarcomas compared with the more common endometrial carcinomas (epithelial neoplasms), behave aggressively and are associated with a poorer prognosis. The rarity of uterine sarcoma has made it difficult to perform large studies to identify risk factors. What do the results of this study add? Complete cytoreduction improves the DFS and OS and may be a valuable prognostic factor. Poorer DFS and OS prognosis was observed in undifferentiated endometrial sarcomas. What are the implications of these findings for clinical practice and/or further research? Our results demonstrate the importance of an early diagnosis, and thus an early identification of disease that benefits from complete cytoreduction regardless of histology. For the advanced clinical stage of uterine sarcomas further research is necessary and participation in clinical trials should be encouraged.
子宫肉瘤是罕见的异质性间叶组织肿瘤，具有侵袭性特征且临床预后较差。本研究旨在描述与子宫肉瘤相关的预后因素。回顾了2000年至2014年间诊断为子宫肉瘤并最初接受手术治疗的女性的临床记录。进行了组织学比较。计算并比较了总生存期（OS）和无病生存期（DFS）。73名女性接受了手术（12.3%为子宫内膜间质肉瘤，24.7%为未分化子宫内膜肉瘤，49.3%为平滑肌肉瘤，13.7%为其他亚型）。完全细胞减灭术的平均DFS为25.1个月，而不完全细胞减灭术的平均DFS为4.33个月（p = 0.04）。完全细胞减灭术的五年OS中位数未达到；不完全细胞减灭术的OS为10.1个月（p = 0.002）。我们的数据表明，未分化子宫内膜肉瘤的DFS最低（p = 0.004）；而OS受IV期负面影响（p < 0.001）。影响声明关于该主题已知的信息是什么？与更常见的子宫内膜癌（上皮性肿瘤）相比，子宫肉瘤具有侵袭性，预后较差。子宫肉瘤的罕见性使得难以进行大型研究来确定危险因素。本研究的结果增加了什么？完全细胞减灭术可改善DFS和OS，可能是一个有价值的预后因素。未分化子宫内膜肉瘤的DFS和OS预后较差。这些发现对临床实践和/或进一步研究有何意义？我们的结果证明了早期诊断的重要性，因此早期识别无论组织学如何都能从完全细胞减灭术中获益的疾病。对于子宫肉瘤的晚期临床阶段，有必要进行进一步研究并鼓励参与临床试验。
