Arrastia C D, Fruchter R G, Clark M, Maiman M, Remy J C, Macasaet M, Gates E J, Di Maio T, Marzec T
Department of Obstetrics and Gynecology, State University of New York-Health Science Center at Brooklyn, 11203, USA.
Gynecol Oncol. 1997 Apr;65(1):158-63. doi: 10.1006/gyno.1997.4629.
Our study's aim was to determine the incidence of uterine sarcomas in New York City (NYC) and evaluate trends in frequency, treatment, and survival of carcinosarcomas in two Brooklyn hospitals. Population-based cancer registry data for 1976-1985 were used to calculate the incidence of uterine sarcomas in NYC women. Medical records and histology slides of carcinosarcomas at two central Brooklyn hospitals from 1960 to 1995 were reviewed. The incidence of uterine sarcomas in black and white women in NYC was 33.4 and 17.0 per million (P < 0.01). Among 97 women with carcinosarcomas diagnosed in 1960-1995, 75% were diagnosed preoperatively, 82% had a hysterectomy, and 45% of those in clinical stage I were upstaged. Predictors of mortality included the presence of extrauterine extension, deep myometrial invasion, vascular space invasion, and gross residual disease, with only the first two being independent predictors of survival in a multivariate analysis. Adjunctive therapy shifted from radiation in 1960-1969 to cisplatin-based chemotherapy after 1980. In surgical stage III, survival increased significantly between 1960-1979 and 1980-1995, but improvement could not be ascribed to particular therapies. The incidence of uterine sarcomas in black women was twice that in white women. Surgical staging including omentectomy is recommended in the management of carcinosarcomas. Modern medical care may have improved the short-term prognosis of carcinosarcomas.
我们研究的目的是确定纽约市（NYC）子宫肉瘤的发病率，并评估布鲁克林两家医院中癌肉瘤在发病频率、治疗及生存方面的趋势。利用1976 - 1985年基于人群的癌症登记数据来计算纽约市女性子宫肉瘤的发病率。对布鲁克林两家中心医院1960年至1995年癌肉瘤的病历和组织学切片进行了回顾。纽约市黑人和白人女性子宫肉瘤的发病率分别为每百万人33.4例和17.0例（P < 0.01）。在1960 - 1995年诊断出的97例癌肉瘤女性患者中，75%在术前得到诊断，82%接受了子宫切除术，临床I期患者中有45%出现分期上调。死亡的预测因素包括子宫外扩展、肌层深部浸润、血管间隙浸润和大体残留病灶，在多变量分析中只有前两项是生存的独立预测因素。辅助治疗从1960 - 1969年的放射治疗转变为1980年后基于顺铂的化疗。在手术III期，1960 - 1979年和1980 - 1995年之间生存率显著提高，但改善不能归因于特定治疗。黑人女性子宫肉瘤的发病率是白人女性的两倍。在癌肉瘤的治疗中，建议进行包括大网膜切除术在内的手术分期。现代医疗护理可能改善了癌肉瘤的短期预后。
