Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra, Spain.
Clin Transl Oncol. 2021 Jun;23(6):1210-1219. doi: 10.1007/s12094-020-02512-6. Epub 2020 Nov 18.
To review the diagnostic and therapeutic procedures of patients diagnosed with Endometrial Stromal Sarcoma (ESS) and Undifferentiated Uterine Sarcoma (USS) at our institution and investigate their clinical outcomes and factors affecting prognosis.
We retrospectively collected demographic data, preoperative diagnostic methods and therapeutic management of patients treated for ESS and UUS between January 1995 and December 2019 at Vall d'Hebron Barcelona Hospital Campus, Spain. Overall survival and disease-free survival were calculated. Cox proportional-hazards regression models were calculated.
Sixty-three patients were included in the study, of which 51(81%) had a diagnosis of ESS and 12(19%) of UUS. Twenty patients (31.7%) were diagnosed after a previous non-oncologic surgery, and 12 of them (60%) suffered from tumor disruption. Cytoreductive procedures were needed in 29 patients (46%), and optimal cytoreduction was achieved in 80.9% of the patients. The median follow-up was 7.6 years (IQR = 0.99-14.31). Five-year overall survival was 57.6% (44.2-68.8) and was significantly better for low-grade ESS (LG-ESS) patients (p < 0.01). Five-year disease-free survival was 57.1% (42.8-69.1) and was also significantly higher in LG-ESS cohort (p = 0.03). After multivariate analysis histological type, age, FIGO stage, optimal surgery and mitotic index were found significantly correlated with survival. For high-grade EES (HG-ESS) and USS patients adjuvant radiotherapy also correlated with improved survival.
Overall survival and disease-free survival are significantly better in patients with LG-ESS cohort. HG-ESS and UUS show similar survival outcomes. Age, FIGO stage, optimal surgery and histological type were significantly correlated with survival in the global cohort, whilst adjuvant radiotherapy correlated with improved survival in HG-ESS and UUS patients.
回顾我院收治的子宫内膜间质肉瘤（ESS）和未分化子宫肉瘤（USS）患者的诊断和治疗过程，并探讨其临床结果和影响预后的因素。
我们回顾性收集了 1995 年 1 月至 2019 年 12 月在西班牙巴塞罗那瓦尔登赫布隆医院接受 ESS 和 UUS 治疗的患者的人口统计学数据、术前诊断方法和治疗管理。计算总生存率和无病生存率。计算 Cox 比例风险回归模型。
本研究共纳入 63 例患者，其中 51 例（81%）诊断为 ESS，12 例（19%）诊断为 USS。20 例（31.7%）患者在非肿瘤手术后继发诊断，其中 12 例（60%）发生肿瘤破裂。29 例（46%）患者需要进行细胞减灭术，80.9%的患者达到了最佳细胞减灭术。中位随访时间为 7.6 年（IQR=0.99-14.31）。5 年总生存率为 57.6%（44.2-68.8），低级别 ESS（LG-ESS）患者的生存率明显更好（p<0.01）。5 年无病生存率为 57.1%（42.8-69.1），LG-ESS 组也明显较高（p=0.03）。多变量分析发现组织学类型、年龄、FIGO 分期、最佳手术和有丝分裂指数与生存显著相关。对于高级别 EES（HG-ESS）和 USS 患者，辅助放疗也与生存率的提高相关。
LG-ESS 患者的总生存率和无病生存率明显更好。HG-ESS 和 USS 的生存结果相似。年龄、FIGO 分期、最佳手术和组织学类型与全队列的生存显著相关，而辅助放疗与 HG-ESS 和 USS 患者生存率的提高相关。
