Huo Lanqing, Wang Dan, Wang Wenze, Cao Dongyan, Yang Jiaxin, Wu Ming, Yang Junjun, Xiang Yang
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2020 May 14;10:647. doi: 10.3389/fonc.2020.00647. eCollection 2020.
The term "uterine smooth muscle tumor of uncertain malignant potential" (STUMP) indicates a rare tumor that cannot be classified as a benign leiomyoma or malignant leiomyosarcoma. In this study, we assessed the clinical characteristics, fertility, and oncologic outcomes of patients diagnosed as STUMP in 14 years. In addition, we analyzed the risk factors for recurrence in patients with STUMP. Medical records of STUMP patients at Peking Union Medical College Hospital (PUMCH) between January 2005 and June 2019 were reviewed and analyzed. Disease-free survival, age of diagnosis, tumor size, surgical procedure, pathology and immunohistochemistry, clinical characteristics, recurrence rate, and reproductive outcomes in the follow-up period were assessed. Univariate and multivariate analyses were performed to determine the prognostic factors. The median age was 42 years old (range: 21-63). Total hysterectomy with or without bilateral salpingo-oophorectomy was performed in 29/67 cases (43.3%), and myomectomy was performed in 38/67 cases (56.7%). Ten patients experienced recurrences, and all but two recurrences occurred within 5 years after the initial surgery. Only two of these recurrences were leiomyosarcoma. There were no deaths in the median follow-up period of 48.4 (range 2.6-170.2) months. There were no remarkable differences in location of tumor between the myomectomy and hysterectomy groups, but the patients in the myomectomy group were younger than those in the hysterectomy group. In univariate and multivariate analysis, mitosis on pathology was the only independent risk factor for recurrence. Expression of Ki-67, p53, and p16 was significantly higher in patients with recurrence. Seven of the 35 patients who attempted to conceive had successful pregnancies. The prognosis of STUMP was favorable and tumors with more than 10 mitoses per 10 high power field should be monitored closely. The surgical procedure was not an independent risk factor of recurrence, and myomectomy may be an acceptable option for patients wishing to preserve fertility.
“具有不确定恶性潜能的子宫平滑肌肿瘤”（STUMP）是指一种罕见的肿瘤，无法归类为良性平滑肌瘤或恶性平滑肌肉瘤。在本研究中，我们评估了14年间被诊断为STUMP的患者的临床特征、生育能力和肿瘤学结局。此外，我们分析了STUMP患者复发的危险因素。回顾并分析了北京协和医院（PUMCH）2005年1月至2019年6月期间STUMP患者的病历。评估了无病生存期、诊断年龄、肿瘤大小、手术方式、病理及免疫组化、临床特征、复发率以及随访期间的生殖结局。进行单因素和多因素分析以确定预后因素。中位年龄为42岁（范围：21 - 63岁）。67例中有29例（43.3%）进行了全子宫切除术，可选择或不选择双侧输卵管卵巢切除术，38例（56.7%）进行了肌瘤切除术。10例患者复发，除2例复发外，所有复发均发生在初次手术后5年内。这些复发中只有2例为平滑肌肉瘤。在中位随访期48.4个月（范围2.6 - 170.2个月）内无死亡病例。肌瘤切除术组和子宫切除术组之间肿瘤位置无显著差异，但肌瘤切除术组患者比子宫切除术组患者年轻。在单因素和多因素分析中，病理上的核分裂象是复发的唯一独立危险因素。复发患者中Ki-67、p53和p16的表达明显更高。35例尝试怀孕的患者中有7例成功妊娠。STUMP的预后良好，每10个高倍视野有超过10个核分裂象的肿瘤应密切监测。手术方式不是复发的独立危险因素，对于希望保留生育能力的患者，肌瘤切除术可能是一个可接受的选择。
