Dondi Giulia, Porcu Eleonora, De Palma Alessandra, Damiano Giuseppe, De Crescenzo Eugenia, Cipriani Linda, Dirodi Maria, Ravegnini Gloria, De Leo Antonio, Nannini Margherita, Ferioli Martina, Morganti Alessio G, Pantaleo Maria Abbondanza, De Iaco Pierandrea, Perrone Anna Myriam
Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy.
Cancers (Basel). 2021 Nov 19;13(22):5808. doi: 10.3390/cancers13225808.
Uterine sarcomas are rare cancers, sometimes diagnosed in women of childbearing age. Hysterectomy is the standard treatment in early stages. The option of lesion removal to save fertility is described in the literature, but it is still considered experimental. The objective of this systematic review is to report on the available evidence on the reproductive and oncological outcomes of fertility-sparing treatment in women with uterine sarcomas. PubMed, Scopus and Cochrane Central Register of Controlled Trials were searched between 1 January 2011 and 21 June 2021 for publications in English about women with uterine sarcoma treated with a fertility-sparing intervention. Thirty-seven studies were included for a total of 210 patients: 63 low-grade endometrial stromal sarcomas, 35 embryonal rhabdomyosarcomas of the cervix, 19 adenosarcomas, 7 leiomyosarcomas and 2 uterine tumors resembling an ovarian sex cord. Conservative treatment ensured pregnancy in 32% of cases. In terms of oncological outcomes, relapse was related to histology and the worst prognosis was reported for leiomyosarcoma, followed by low-grade endometrial stromal sarcoma, which relapsed in 71% and 54% of cases, respectively. The highest death rate was associated with leiomyosarcoma (57.1%). This study demonstrated that fertility-sparing treatments may be employed in selected cases of early stage uterine sarcoma.
子宫肉瘤是罕见的癌症，有时在育龄女性中被诊断出来。子宫切除术是早期的标准治疗方法。文献中描述了切除病灶以保留生育能力的选择，但仍被认为是实验性的。本系统评价的目的是报告关于子宫肉瘤女性保留生育功能治疗的生殖和肿瘤学结局的现有证据。在2011年1月1日至2021年6月21日期间，对PubMed、Scopus和Cochrane对照试验中央注册库进行了检索，以查找有关接受保留生育功能干预治疗的子宫肉瘤女性的英文出版物。纳入了37项研究，共210例患者：63例低级别子宫内膜间质肉瘤、35例宫颈胚胎性横纹肌肉瘤、19例腺肉瘤、7例平滑肌肉瘤和2例类似卵巢性索的子宫肿瘤。保守治疗在32%的病例中确保了妊娠。在肿瘤学结局方面，复发与组织学有关，平滑肌肉瘤的预后最差，其次是低级别子宫内膜间质肉瘤，其复发率分别为71%和54%。最高死亡率与平滑肌肉瘤相关（57.1%）。这项研究表明，保留生育功能的治疗可用于早期子宫肉瘤患者的特定病例。
