Chen Jingying, Bu Hualei, Zhang Zhaoyang, Chu Ran, Qi Gonghua, Zhao Chen, Wang Qiuman, Ma Xinyue, Wu Huan, Dou Zhiyuan, Wang Xia, Kong Beihua
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.
Gynecologic Oncology Key Laboratory of Shandong Province, Qilu Hospital of Shandong University, Jinan, China.
Front Surg. 2023 Jan 30;9:1020004. doi: 10.3389/fsurg.2022.1020004. eCollection 2022.
The treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence.
A retrospective study was conducted on IVL patients from the Qilu Hospital of Shandong University, and IVL cases were published in PubMed, MEDLINE, Embase and Cochrane Library databases. Descriptive statistics were used for the basic characteristics of patients. The Cox proportional hazards regression analysis was used to assess the high-risk factors related to the progression-free survival (PFS). The comparison of survival curves was performed by Kaplan-Meier analysis.
A total of 361 IVL patients were included in this study, 38 patients from Qilu Hospital of Shandong University, and 323 patients from the published literature. Age ≤45 years was observed in 173 (47.9%) patients. According to the clinical staging criteria, stage I/II was observed in 125 (34.6%) patients, and stage III/IV was observed in 221 (61.2%) patients. Dyspnea, orthopnea, and cough were observed in 108 (29.9%) patients. Completed tumor resection was observed in 216 (59.8%) patients, and uncompleted tumor resection was observed in 58 (16.1%) patients. Median follow-up period was 12 months (range 0-194 months), and 68 (18.8%) recurrences or deaths were identified. The adjusted multivariable Cox proportional hazard analysis showed age ≤45 years (vs. >45) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.15-3.80, = 0.016), and uncompleted tumor resection (vs. completed tumor resection) (HR = 22.03, 95% CI 8.31-58.36, < 0.001) were high-risk factors related to the PFS.
Patients with IVL have a high probability of recurrence after surgery and a poor prognosis. Patients younger than 45 years and with uncompleted tumor resection are at higher risk of postoperative recurrence or death.
静脉内平滑肌瘤病（IVL）的治疗方法和预后因素仍缺乏系统性证据。
对山东大学齐鲁医院的IVL患者进行回顾性研究，并检索PubMed、MEDLINE、Embase和Cochrane图书馆数据库中发表的IVL病例。采用描述性统计分析患者的基本特征。采用Cox比例风险回归分析评估与无进展生存期（PFS）相关的高危因素。采用Kaplan-Meier分析比较生存曲线。
本研究共纳入361例IVL患者，其中山东大学齐鲁医院38例，已发表文献323例。173例（47.9%）患者年龄≤45岁。根据临床分期标准，125例（34.6%）患者为Ⅰ/Ⅱ期，221例（61.2%）患者为Ⅲ/Ⅳ期。108例（29.9%）患者出现呼吸困难、端坐呼吸和咳嗽。216例（59.8%）患者完成了肿瘤切除，58例（16.1%）患者未完成肿瘤切除。中位随访期为12个月（范围0 - 194个月），68例（18.8%）复发或死亡。校正后的多变量Cox比例风险分析显示，年龄≤45岁（对比>45岁）（风险比[HR]=2.09，95%置信区间[CI] 1.15 - 3.80，P = 0.016），以及未完成肿瘤切除（对比完成肿瘤切除）（HR = 22.03，95% CI 8.31 - 58.36，P < 0.001）是与PFS相关的高危因素。
IVL患者术后复发概率高，预后差。年龄小于45岁且未完成肿瘤切除的患者术后复发或死亡风险更高。
