Patel Viral, Rajanbabu Anupama, Nair Indu R, Pillai Pramod R, Ravindran Greeshma C
Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India.
Department of Pathology, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India.
Indian J Surg Oncol. 2021 Sep;12(3):581-586. doi: 10.1007/s13193-021-01406-5. Epub 2021 Aug 7.
Uterine leiomyosarcoma is a rare female reproductive system tumor which is difficult to distinguish from uterine leiomyoma preoperatively. Manual and power morcellation are used to remove the large uterus through the vagina or small abdominal incision. Worse outcome with use of power morcellation is now clear but impact of manual morcellation on survival outcome not established till date. The objective of the present study was to find impact of tumor spillage and to evaluate influencing factors for oncological outcome and prognosis in uterine leiomyosarcoma patients. This is a single-institutional retrospective cohort study including all uterine leiomyosarcoma patients from January 2005 to December 2017. Role of intraoperative tumor spillage and other influencing factors on oncological outcome were assessed. Thirty-three patients with median follow-up period of 49.7 months were evaluated. Stage 1 and absence of tumor spill had significant association with prolonged progression-free survival. Stage 1 uterine leiomyosarcoma (56.8 vs 6.8 months, = < 0.001), intraoperative tumor spillage ( = 0.03) and progression-free survival > 15 months (68.5 vs 12.2 months, = < 0.001) were favourable prognostic factors to predict better survival outcome but unable to establish significance on multivariate analysis. Survival plot did not reach median limit for stage I uterine leiomyosarcoma patients with preoperative suspicion. Age, site of recurrence and mitotic index had no significant association with better survival in the present study. Stage I disease and absence of tumor spillage during surgery improved progression-free survival but did not affect overall survival. Progression-free survival more than 15 months can predict better overall survival.
子宫平滑肌肉瘤是一种罕见的女性生殖系统肿瘤，术前很难与子宫平滑肌瘤区分开来。手动和电动粉碎术用于通过阴道或小腹部切口切除大子宫。现在已经明确电动粉碎术的不良后果，但迄今为止手动粉碎术对生存结果的影响尚未确定。本研究的目的是探讨肿瘤播散的影响，并评估子宫平滑肌肉瘤患者肿瘤学结局和预后的影响因素。这是一项单机构回顾性队列研究，纳入了2005年1月至2017年12月期间所有子宫平滑肌肉瘤患者。评估了术中肿瘤播散和其他影响因素对肿瘤学结局的作用。对33例患者进行了评估，中位随访期为49.7个月。Ⅰ期和无肿瘤播散与无进展生存期延长显著相关。Ⅰ期子宫平滑肌肉瘤（56.8个月对6.8个月，P＜0.001）、术中肿瘤播散（P = 0.03）和无进展生存期＞15个月（68.5个月对12.2个月，P＜0.001）是预测更好生存结局的有利预后因素，但在多因素分析中未能确立其显著性。术前有怀疑的Ⅰ期子宫平滑肌肉瘤患者的生存曲线未达到中位极限。在本研究中，年龄、复发部位和有丝分裂指数与较好的生存无显著关联。Ⅰ期疾病和手术中无肿瘤播散可改善无进展生存期，但不影响总生存期。无进展生存期超过15个月可预测更好的总生存期。
