子宫切除术中双侧卵巢切除术与保留卵巢术治疗静脉内平滑肌瘤病患者的临床结局比较

Clinical Outcomes of Bilateral Oophorectomy Compared With Ovarian Preservation in Patients With Intravenous Leiomyomatosis Who Underwent Hysterectomy.

作者信息

Shi Peipei, Peng Jing, Chen Xiaoyue, Lu Cong, Li Shuangdi, Li Tingting, Zhang Jiarong, Yin Sheng

机构信息

Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, the Obstetrics and Gynecology Hospital of Fudan University, the Department of Gynecology, School of Medicine, Shanghai First Maternity and Infant Hospital, Tong Ji University, and the Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Obstet Gynecol. 2025 Jul 31;146(3):377-385. doi: 10.1097/AOG.0000000000006018.

DOI:10.1097/AOG.0000000000006018

PMID:40743527

Abstract

OBJECTIVE

Intravenous leiomyomatosis is a rare, histologically benign yet biologically aggressive smooth muscle tumor. Previous studies have indicated that ovarian hormones may play a crucial role in the pathogenesis of intravenous leiomyomatosis. However, the question of whether the deprivation of ovarian estrogen, including bilateral oophorectomy, reduces tumor recurrence in intravenous leiomyomatosis remains unclear.

METHODS

This retrospective cohort study, conducted across multiple centers in China from August 2003 to July 2023, focused on premenopausal patients with intravenous leiomyomatosis who underwent hysterectomy. Patients were categorized into either the bilateral oophorectomy group or the ovarian preservation group. The study compared disease-free survival (DFS) between these two groups. Univariate and multivariate analyses were employed to identify factors associated with DFS.

RESULTS

The study included 219 patients, with 132 (60.3%) in the bilateral oophorectomy group and 87 (39.7%) in the ovarian preservation group. Generally, patients in the bilateral oophorectomy group were older, were more likely to have given birth, and had a higher proportion of extrauterine disease compared with those in the ovarian preservation group. Kaplan-Meier curves showed significantly lower recurrence rates in the bilateral oophorectomy group compared with the ovarian preservation group ( P =.01). The cumulative recurrence rates at 3 years, 5 years, and 10 years were 0.8%, 2.6%, and 4.0%, respectively, in the bilateral oophorectomy group and 9.0%, 10.3%, and 14.0%, respectively, in the ovarian preservation group. Multivariate analysis for DFS demonstrated that ovarian preservation significantly increased the risk of tumor recurrence (adjusted hazard ratio 0.14, 95% CI, 0.04-0.52, P =.003).

CONCLUSION

Simultaneous bilateral oophorectomy may reduce the risk of tumor recurrence for premenopausal women diagnosed with intravenous leiomyomatosis who undergo hysterectomy.

摘要

目的

静脉内平滑肌瘤病是一种罕见的、组织学上为良性但生物学行为具有侵袭性的平滑肌肿瘤。既往研究表明，卵巢激素可能在静脉内平滑肌瘤病的发病机制中起关键作用。然而，包括双侧卵巢切除术在内的卵巢雌激素剥夺是否能降低静脉内平滑肌瘤病的肿瘤复发率仍不明确。

方法

本回顾性队列研究于2003年8月至2023年7月在中国多个中心开展，聚焦于接受子宫切除术的绝经前静脉内平滑肌瘤病患者。患者被分为双侧卵巢切除术组或卵巢保留组。本研究比较了两组的无病生存期（DFS）。采用单因素和多因素分析来确定与DFS相关的因素。

结果

本研究纳入219例患者，其中双侧卵巢切除术组132例（60.3%），卵巢保留组87例（39.7%）。总体而言，与卵巢保留组患者相比，双侧卵巢切除术组患者年龄更大，生育可能性更高，子宫外疾病比例更高。Kaplan-Meier曲线显示，双侧卵巢切除术组的复发率显著低于卵巢保留组（P = 0.01）。双侧卵巢切除术组3年、5年和10年的累积复发率分别为0.8%、2.6%和4.0%，卵巢保留组分别为9.0%、10.3%和14.0%。DFS的多因素分析表明，保留卵巢显著增加了肿瘤复发风险（调整后风险比0.14，95%CI，0.04 - 0.52，P = 0.003）。