子宫癌肉瘤的预后因素：25例患者的临床病理研究

Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients.

作者信息

Iwasa Y, Haga H, Konishi I, Kobashi Y, Higuchi K, Katsuyama E, Minamiguchi S, Yamabe H

机构信息

Laboratory of Anatomic Pathology, Kyoto University Hospital, Japan.

出版信息

Cancer. 1998 Feb 1;82(3):512-9.

PMID:9452269

Abstract

BACKGROUND

Carcinosarcoma (malignant mixed mullerian tumor) of the female genital tract is a highly malignant neoplasm. The tumor stage and histologic grade of the carcinomatous component are among the important prognostic indicators cited in the literature for this tumor.

METHODS

Twenty-five patients with uterine carcinosarcoma at 4 hospitals in the Kyoto and Nara areas of Japan were studied retrospectively. The clinicopathologic and immunohistochemical data including p53, bcl-2, Ki-67, and proliferating cell nuclear antigen (PCNA) staining were analyzed using univariate and multivariate analysis with the Cox proportional hazards model to investigate potential prognostic indicators for this neoplasm.

RESULTS

The 5-year survival rate was 36.4% for all stages, 62.3% for Stage I, and 0% for Stages II-IV. From the univariate analysis, stage (P = 0.0001), endometrioid adenocarcinoma as a carcinomatous component (P = 0.0006), age (P = 0.0355), and a heterologous sarcomatous component (P = 0.0421) were found to be prognostically significant for patient survival. Stage was the only independent significant factor in the multivariate analysis (t = 2.212). None of the other factors (history of pregnancy and gestation, gross appearance of the tumors, grade of the carcinomatous component, mitotic count of the sarcomatous component, Ki-67 and PCNA reactivity, or p53 or bcl-2 positive staining) was found to be a significant prognostic indicator.

CONCLUSIONS

Stage appears to be the only definite independent prognostic indicator of survival in patients with uterine carcinosarcoma. It is uncertain whether age, endometrioid adenocarcinoma as a carcinomatous component, or absence of a heterologous component in the sarcomatous area are prognostic factors. Immunohistochemical expression of p53, bcl-2, Ki-67, or PCNA is not a prognostic indicator. The immunohistochemical results of the current study may support the hypothesis of a common stem cell origin of this tumor.

摘要

背景

女性生殖道癌肉瘤（恶性混合苗勒管肿瘤）是一种高度恶性的肿瘤。癌性成分的肿瘤分期和组织学分级是该肿瘤文献中提及的重要预后指标。

方法

对日本京都和奈良地区4家医院的25例子宫癌肉瘤患者进行回顾性研究。使用Cox比例风险模型对包括p53、bcl-2、Ki-67和增殖细胞核抗原（PCNA）染色在内的临床病理和免疫组化数据进行单因素和多因素分析，以研究该肿瘤潜在的预后指标。

结果

所有分期患者的5年生存率为36.4%，I期为62.3%，II-IV期为0%。单因素分析发现，分期（P = 0.0001）、作为癌性成分的子宫内膜样腺癌（P = 0.0006）、年龄（P = 0.0355）和异源性肉瘤成分（P = 0.0421）对患者生存具有预后意义。分期是多因素分析中唯一的独立显著因素（t = 2.212）。未发现其他因素（妊娠和生育史、肿瘤大体外观、癌性成分分级、肉瘤成分的有丝分裂计数、Ki-67和PCNA反应性，或p53或bcl-2阳性染色）是显著的预后指标。