Li Jessie Y, Mutlu Levent, Tymon-Rosario Joan, Khadraoui Wafa, Nagarkatti Nupur, Hui Pei, Buza Natalia, Lu Lingeng, Schwartz Peter, Menderes Gulden
Yale University School of Medicine, New Haven, CT, USA.
Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA.
Gynecol Oncol Rep. 2021 Dec 20;39:100913. doi: 10.1016/j.gore.2021.100913. eCollection 2022 Feb.
To examine clinicopathologic characteristics and oncologic outcomes of patients diagnosed with Mullerian adenosarcoma and to evaluate ovarian preservation as a practical management option in early-stage disease.
A retrospective review was performed of 31 patients treated for uterine, ovarian, or cervical adenosarcoma at our institution between 1/2000-3/2020. Recurrence-free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards regression.
Median age was 51 years (IQR: 41-68). Primary sites included uterine corpus (n = 23, 74.2%), uterine cervix (n = 7, 22.6%), and ovary (n = 1, 3.2%). Surgical management primarily consisted of total hysterectomy +/- bilateral adnexectomy +/- lymph node dissection. Fifteen (48.1%) patients underwent lymph node dissection; no patients had positive nodes. Ovaries were preserved in 6 (19.4%). Twenty-two (71.0%) patients received no adjuvant therapy, 4 (12.9%) received chemotherapy, 1 (3.2%) received chemoradiation, and 3 (9.7%) received hormonal therapy. Sarcomatous overgrowth (p = 0.04), high grade histology (p = 0.002), and greater depth of myometrial invasion (p = 0.001) were associated with decreased RFS. None of the 6 patients with ovarian preservation had recurrences. At last follow up, 21 patients (67.7%) had no evidence of disease, 7 (22.6%) were deceased due to disease, and 3 (9.7%) were deceased due to non-cancerous reasons.
Uterine adenosarcoma appears to have a relatively good prognosis, especially in the absence of risk factors, such as sarcomatous overgrowth, high grade histology, and deep myometrial invasion. Ovarian preservation may be a feasible management option with non-inferior outcomes for premenopausal women with early-stage disease. Future studies including larger patient cohorts are needed for this rare disease.
研究诊断为苗勒管腺肉瘤患者的临床病理特征和肿瘤学结局，并评估保留卵巢作为早期疾病一种可行的治疗选择。
对2000年1月至2020年3月间在本机构接受子宫、卵巢或宫颈腺肉瘤治疗的31例患者进行回顾性研究。采用Kaplan-Meier估计法、对数秩检验和Cox比例风险回归分析无复发生存期（RFS）和总生存期（OS）。
中位年龄为51岁（四分位间距：41-68岁）。原发部位包括子宫体（n = 23，74.2%）、子宫颈（n = 7，22.6%）和卵巢（n = 1，3.2%）。手术治疗主要包括全子宫切除术±双侧附件切除术±淋巴结清扫术。15例（48.1%）患者接受了淋巴结清扫术；无患者淋巴结阳性。6例（19.4%）患者保留了卵巢。22例（71.0%）患者未接受辅助治疗，4例（12.9%）接受了化疗，1例（3.2%）接受了放化疗，3例（9.7%）接受了激素治疗。肉瘤样过度生长（p = 0.04）、高级别组织学（p = 0.002）和子宫肌层浸润深度增加（p = 0.001）与RFS降低相关。6例保留卵巢的患者均无复发。在最后一次随访时，21例（67.7%）患者无疾病证据，7例（22.6%）因疾病死亡，3例（9.7%）因非癌症原因死亡。
子宫腺肉瘤似乎预后相对较好，尤其是在没有肉瘤样过度生长、高级别组织学和子宫肌层深部浸润等危险因素的情况下。对于早期疾病的绝经前女性，保留卵巢可能是一种可行的治疗选择，其结局不劣。对于这种罕见疾病，需要开展包括更大患者队列的未来研究。
