Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Gynecol Obstet Invest. 2021;86(4):408-414. doi: 10.1159/000515895. Epub 2021 Jul 20.
The aim of this study was to evaluate the impact of initial surgical treatments and surgical re-exploration on the oncological outcomes of patients with incidentally diagnosed uterine leiomyosarcoma (uLMS).
A retrospective analysis of 87 patients who underwent re-exploration for incidentally diagnosed uLMS at the Fudan University Shanghai Cancer Center was performed.
Kaplan-Meier and Cox proportional hazards regression models were used for analyses.
The median age (range) at diagnosis was 49 (23-76) years. The median disease-free survival (DFS) and overall survival (OS) were 15.1 and 56.7 months, respectively. The Kaplan-Meier curves and log-rank tests showed the median DFS was longer in patients with restaging operation (N = 30) than without (N = 55) (p = 0.017) but no significant difference in median OS (p = 0.142). In patients who underwent myomectomy/subtotal hysterectomy, 5 patients (28.5%) had remnant sarcoma during re-exploration with complete uterine removal, and re-exploration was associated with longer DFS (p = 0.038) and OS (p = 0.042).
The limitation of this study is its retrospective observational design with a limited number of patients.
Reoperation with total hysterectomy after incomplete surgery may be helpful in patients with incidentally diagnosed uLMS at the first treatment.
本研究旨在评估初次手术治疗和再次手术探查对偶然诊断为子宫平滑肌肉瘤（uLMS）患者的肿瘤学结局的影响。
对复旦大学附属肿瘤医院接受再次手术探查的 87 例偶然诊断为 uLMS 的患者进行回顾性分析。
采用 Kaplan-Meier 和 Cox 比例风险回归模型进行分析。
诊断时的中位年龄（范围）为 49（23-76）岁。中位无疾病生存（DFS）和总生存（OS）分别为 15.1 和 56.7 个月。Kaplan-Meier 曲线和对数秩检验显示，再次手术（N=30）患者的中位 DFS 长于未手术（N=55）患者（p=0.017），但中位 OS 无显著差异（p=0.142）。在接受子宫肌瘤切除术/次全子宫切除术的患者中，5 例（28.5%）在再次探查时发现残留肉瘤，且完全子宫切除与更长的 DFS（p=0.038）和 OS（p=0.042）相关。
本研究的局限性在于其为回顾性观察性设计，患者数量有限。
初次治疗不完全时行全子宫切除术的再次手术可能对偶然诊断为 uLMS 的患者有益。
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