Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng-qu, Beijing, China.
Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng-qu, Beijing, China
Int J Gynecol Cancer. 2024 May 6;34(5):705-712. doi: 10.1136/ijgc-2023-005108.
To analyse the risk factors for post-operative recurrence or progression of intravenous leiomyomatosis and explore the impact of different treatment strategies on patient prognosis.
Patients with intravenous leiomyomatosis who underwent surgery from January 2011 to December 2020 and who were followed for ≥3 months were included. The primary endpoint was recurrence (for patients with complete resection) or progression (for patients with incomplete resection). Kaplan-Meier survival analysis was used to analyse the factors affecting recurrence.
A total of 114 patients were included. The median age was 45 years old (range 24-58). The tumors were confined to the uterus and para-uterine vessels in 48 cases (42.1%), while in 66 cases (57.9%) it involved large vessels (iliac vein or genital vein and/or proximal large veins). The median follow-up time was 24 months (range 3-132). Twenty-nine patients (25.4%) had recurrence or progression. The median recurrence or progression time was 16 months (range 3-60). Incomplete tumor resection (p=0.019), involvement of the iliac vein or genital vein (p=0.042), involvement of the inferior vena cava (p=0.025), and size of the pelvic tumor ≥15 cm (p=0.034) were risk factors for recurrence and progression. For intravenous leiomyomatosis confined to the uterus or para-uterine vessels, no post-operative recurrence after hysterectomy and bilateral oophorectomy occurred in this cohort. Compared with hysterectomy and bilateral oophorectomy, the risk of recurrence after tumorectomy (with the uterus and ovaries retained) was significantly greater (p=0.009), while the risk of recurrence after hysterectomy was not significantly increased (p=0.058). For intravenous leiomyomatosis involving the iliac vein/genital vein and the proximal veins, post-operative aromatase inhibitor treatment (p=0.89) and two-stage surgery (p=0.86) were not related to recurrence in patients with complete tumor resection.
Incomplete tumor resection, extent of tumor lesions and size of the pelvic tumor were risk factors for post-operative recurrence and progression of intravenous leiomyomatosis.
分析静脉内平滑肌瘤病术后复发或进展的危险因素，并探讨不同治疗策略对患者预后的影响。
纳入 2011 年 1 月至 2020 年 12 月期间接受手术且随访时间≥3 个月的静脉内平滑肌瘤病患者。主要终点为完全切除患者的复发或不完全切除患者的进展。采用 Kaplan-Meier 生存分析评估影响复发的因素。
共纳入 114 例患者，中位年龄为 45 岁（范围 24-58 岁）。48 例（42.1%）肿瘤局限于子宫和子宫旁血管，66 例（57.9%）累及大血管（髂静脉或生殖静脉和/或近端大静脉）。中位随访时间为 24 个月（范围 3-132 个月）。29 例（25.4%）患者出现复发或进展。中位复发或进展时间为 16 个月（范围 3-60 个月）。不完全肿瘤切除（p=0.019）、累及髂静脉或生殖静脉（p=0.042）、累及下腔静脉（p=0.025）和盆腔肿瘤大小≥15cm（p=0.034）是复发和进展的危险因素。对于局限于子宫或子宫旁的静脉内平滑肌瘤病，该队列在子宫切除术和双侧卵巢切除术后无术后复发。与子宫切除术和双侧卵巢切除术相比，肿瘤切除术（保留子宫和卵巢）后的复发风险明显更高（p=0.009），而子宫切除术后的复发风险无明显增加（p=0.058）。对于累及髂静脉/生殖静脉和近端静脉的静脉内平滑肌瘤病，完全肿瘤切除术后患者的术后芳香化酶抑制剂治疗（p=0.89）和两阶段手术（p=0.86）与复发无关。
不完全肿瘤切除、肿瘤病变范围和盆腔肿瘤大小是静脉内平滑肌瘤病术后复发和进展的危险因素。
