Yalciner Merih, Bölek Hatice, Berna Köksoy Elif
Medical Oncology, Ankara University School of Medicine, Ankara, TUR.
Cureus. 2023 Aug 18;15(8):e43681. doi: 10.7759/cureus.43681. eCollection 2023 Aug.
Background Uterine leiomyosarcomas (LMS) are associated with more recurrence and higher mortality compared to other uterine cancers. Considering the limited number of case series in the literature, the limited effectiveness of standard treatment methods, and the inadequacy of molecular biomarkers, we planned to investigate the effects of treatment methods and survival outcomes in these patients. Methodology The study was designed retrospectively, and the records of patients who were followed up and treated at Ankara University Faculty of Medicine, Medical Oncology Clinic, between January 1, 2011, and December 31, 2021, were reviewed. Patients over 18 years of age with a pathological diagnosis of uterine LMS were included. Demographic, clinical, and pathological data were recorded using the hospital database. The International Federation of Gynecology and Obstetrics (FIGO) staging was reassessed for each patient in accordance with the AJCC Cancer Staging Manual, Eighth Edition (2017). Tumor size, location, and grade were also evaluated. Types of treatments, protocols, and adverse effects were recorded. Relapsed patients, relapse localization, and treatments given at relapse were recorded and compared. Results Twenty-eight patients were included. The mean age of the patients was 53.7 years. The median follow-up time was 39.3 months. The localization of LMS could be detected in 22 (78.57%) patients, among them 20 (90.9%) patients had intramural, 1 (4.5%) had submucosal, and 1 (4.5%) had subserosal LMS. All patients (26, 92.8%) underwent primary surgery, except for 2 (7.14%) patients who were metastatic at the time of diagnosis. Adjuvant treatment suggestion was made for 7 (25%) patients with a high risk of recurrence in the multidisciplinary tumor council. Partial response was observed in 1 (3.5%) of the 2 (7.1%) metastatic patients, and stable disease was observed in the other. Recurrence was detected in 22 (84.6%) patients . Fifteen (53.6%) patients died during the follow-up period. Survival was better in premenopausal patients (99.2 versus 51.6 months, = 0.056). No significant difference was found when the survival of patients who received and did not receive adjuvant treatment were compared. In relapsed patients, there was no significant difference in survival between patients who underwent and did not undergo surgical treatment. Conclusions Uterine LMS is a rare and aggressive malignancy with limited diagnostic methods, frequent recurrences, high mortality, and limited use of nonsurgical treatments. The positive effect of adjuvant treatment on survival has not been demonstrated. Further studies are needed to investigate the effect of hormone receptor status on prognosis and new biomarkers.
背景 与其他子宫癌相比，子宫平滑肌肉瘤（LMS）的复发率更高，死亡率也更高。鉴于文献中病例系列数量有限、标准治疗方法效果有限以及分子生物标志物不足，我们计划研究这些患者的治疗方法效果和生存结果。方法 本研究为回顾性设计，回顾了2011年1月1日至2021年12月31日在安卡拉大学医学院医学肿瘤诊所接受随访和治疗的患者记录。纳入年龄超过18岁、病理诊断为子宫LMS的患者。使用医院数据库记录人口统计学、临床和病理数据。根据美国癌症联合委员会（AJCC）癌症分期手册第八版（2017年）对每位患者重新评估国际妇产科联盟（FIGO）分期。还评估了肿瘤大小、位置和分级。记录治疗类型、方案和不良反应。记录并比较复发患者、复发部位以及复发时给予的治疗。结果 纳入28例患者。患者的平均年龄为53.7岁。中位随访时间为39.3个月。22例（78.57%）患者可检测到LMS的位置，其中20例（90.9%）为肌壁间LMS，1例（4.5%）为黏膜下LMS，1例（4.5%）为浆膜下LMS。除2例（7.14%）诊断时已发生转移的患者外，所有患者（26例，92.8%）均接受了初次手术。多学科肿瘤委员会对7例（25%）复发风险高的患者提出了辅助治疗建议。2例（7.1%）转移患者中有1例（3.5%）观察到部分缓解，另一例观察到病情稳定。22例（84.6%）患者检测到复发。15例（53.6%）患者在随访期间死亡。绝经前患者的生存期更好（99.2个月对51.6个月，P = 0.056）。比较接受和未接受辅助治疗患者的生存期时未发现显著差异。在复发患者中，接受和未接受手术治疗的患者生存期无显著差异。结论 子宫LMS是一种罕见且侵袭性强的恶性肿瘤，诊断方法有限，复发频繁，死亡率高，非手术治疗应用有限。辅助治疗对生存的积极作用尚未得到证实。需要进一步研究以探讨激素受体状态对预后的影响以及新的生物标志物。
