治疗子宫平滑肌肉瘤骨转移的临床结果和生存情况：6 例报告。
Clinical outcomes and survival following treatment of bone metastases from uterine leiomyosarcoma: A report of 6 cases.
机构信息
Clinic of Gynecology and Obstetrics, Ankara City Hospital, Ankara, Turkey.
Department of Orthopedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2022 Jul;56(4):278-282. doi: 10.5152/j.aott.2022.22002.
OBJECTIVE
This study aimed to analyze the patient-reported outcomes and survival following surgical treatment of bone metastases from (uLMS) uterine leiomyosarcoma.
METHODS
A retrospective review of six patients undergoing surgical procedures for metastatic uLMS over seven years was conducted at a single center. All patients were reviewed for their primary malignancy and characteristics of bone metastasis during follow-up. Clinical presentation of bone metastasis, modality, and the type of treatment related to musculoskeletal involvement were also analyzed. The visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status scale were used pre-and postoperatively to evaluate the patient-reported outcome.
RESULTS
Four patients had solitary bone metastases, whereas multiple bone metastases were diagnosed in two. Of those who had solitary bone metastasis, all of them were treated with wide resection. One of the two patients with multiple bone metastases was also treated with wide resection, and the other was treated with intralesional curettage. Four patients died from primary disease, and two were alive without evidence of disease recurrence. The median survival time following a diagnosis of bone metastasis was 15.0 months (95% CI, 0.6 to 29.4 months). The mean VAS scores for all six patients improved. However, the improvement in ECOG performance status was seen in only four patients.
CONCLUSION
Although the prognosis of uLMS patients with bone metastasis seems poor, wide resection of the solitary bone metastasis may help prolong the overall survival. Performing orthopedic surgeries for the bone metastasis from uLMS in case of intractable pain after palliative radiotherapy, impending or pathological fracture, or solitary disease has been shown to decrease the pain significantly and improve the performance status in the majority.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
目的
本研究旨在分析（uLMS）子宫平滑肌肉瘤骨转移患者接受手术治疗后的患者报告结局和生存情况。
方法
在一家单中心对 7 年内接受转移性 uLMS 手术治疗的 6 例患者进行了回顾性研究。所有患者均接受了原发性恶性肿瘤和随访期间骨转移特征的回顾。还分析了骨转移的临床表现、治疗方式以及与肌肉骨骼受累相关的治疗类型。术前和术后均使用视觉模拟疼痛量表（VAS）和东部合作肿瘤学组（ECOG）表现状态量表评估患者的报告结果。
结果
4 例患者有单发骨转移，2 例患者有多发性骨转移。在单发骨转移的患者中，所有患者均接受了广泛切除术。2 例多发性骨转移患者中，1 例接受了广泛切除术，另 1 例接受了病灶内刮除术。4 例患者死于原发性疾病，2 例患者无疾病复发且存活。诊断为骨转移后，中位生存时间为 15.0 个月（95%CI，0.6 至 29.4 个月）。6 例患者的平均 VAS 评分均有所改善。然而，只有 4 例患者的 ECOG 表现状态得到改善。
结论
尽管 uLMS 患者骨转移的预后似乎较差，但广泛切除单发骨转移可能有助于延长总体生存时间。对 uLMS 骨转移患者进行骨科手术，如果姑息性放疗后出现难治性疼痛、即将发生或病理性骨折或单发疾病，可显著减轻疼痛并改善大多数患者的表现状态。
证据水平
IV 级，治疗性研究。
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