Di Giuseppe Jacopo, Grelloni Camilla, Giuliani Lucia, Delli Carpini Giovanni, Giannella Luca, Ciavattini Andrea
Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via Filippo Corridoni, 16, 60123 Ancona, Italy.
Cancers (Basel). 2022 May 7;14(9):2323. doi: 10.3390/cancers14092323.
Background: This study aimed to systematically review the existing literature on uterine smooth muscle tumor of uncertain malignant potential (STUMP) to provide information about characteristics and outcomes of patients and the risk factors for recurrence over a period of 60 years (1960−2021). Methods: According to PRISMA guidelines, we searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed (all fields) and Scopus (Title/Abstract/Keywords) databases (accessed on 1 January 2022). Relevant articles were obtained in full-text format and screened for additional references. The only filter used was the English language. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: Thirty-four studies, including 189 cases, were included. The median age was 43 years, and in 21.5% of cases there was a recurrence of the disease. Bivariate analysis showed a significant association between use of morcellation without bag and risk of recurrence (p = 0.001). Unprotected morcellation during demolitive or conservative surgery was independently associated with a higher risk of disease recurrence with a relative risk of 2.94 (p < 0.001). A significant progressive decrease in the recurrence rate was observed over time (r = −0.671, p = 0.008). The percentage of patients who underwent surgery followed by in-bag protected morcellation significantly increased after the publication of the U.S. Food and Drug Administration alert about the risk linked to this procedure (p = 0.01). Conclusions: Unprotected morcellation of the lesion is associated with the relapse of the disease. However, this clinical condition showed a drastic decrease over time. This could likely be due to the increased awareness by surgeons of the importance of customizing surgical treatment.
本研究旨在系统回顾关于具有不确定恶性潜能的子宫平滑肌肿瘤（STUMP）的现有文献，以提供60年（1960 - 2021年）期间患者的特征、结局以及复发风险因素的信息。方法：根据PRISMA指南，我们在PubMed（所有字段）和Scopus（标题/摘要/关键词）数据库（于2022年1月1日访问）中搜索“具有不确定恶性潜能的子宫平滑肌肿瘤”。以全文格式获取相关文章并筛选其他参考文献。仅使用英语作为筛选条件。纳入符合斯坦福标准且对STUMP患者进行组织病理学诊断的完整病例描述的研究。结果：共纳入34项研究，包括189例病例。中位年龄为43岁，21.5%的病例出现疾病复发。双变量分析显示，使用无袋粉碎术与复发风险之间存在显著关联（p = 0.001）。在拆除性或保守性手术期间进行无保护粉碎术与疾病复发风险较高独立相关，相对风险为2.94（p < 0.001）。随着时间的推移，复发率显著逐步下降（r = -0.671，p = 0.008）。在美国食品药品监督管理局发布关于该手术相关风险的警示后，接受手术并进行袋内保护粉碎术的患者百分比显著增加（p = 0.01）。结论：病变的无保护粉碎术与疾病复发相关。然而，这种临床情况随时间推移有显著下降。这可能是由于外科医生对定制手术治疗重要性的认识提高所致。
