低级别子宫内膜间质肉瘤不同年龄段的临床对比分析
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摘要
目的:探讨不同年龄段低级别子宫内膜间质肉瘤(LG-ESS)在临床表现、肿瘤情况、临床分期、预后等方面的差异。方法:回顾性分析2010年9月至2015年3月四川大学华西第二医院妇科收治的61例LG-ESS患者的临床病理资料和随访资料。对比不同年龄组[≤40岁(29例)和>40岁(32例)],以及年轻患者(≤40岁)中有症状组(15例)和无症状组(14例)间在临床表现及预后等方面的差异。结果:①61例患者平均年龄39.61±9.47岁(17～60岁),其中国际妇产科联盟(FIGO)Ⅰ期47例(77.05%),无明显临床症状患者19例(31.15%)。②≤40岁组与>40岁组比较,单发肿瘤比例(89.65%vs 59.37%)、单发肿瘤最大直径(6.84±2.20 cm vs 6.34±3.83 cm)、无临床症状的比例(48.28%vs 15.63%)差异均有统计学意义(P<0.05)。③不同年龄组FIGO分期比较,差异无统计学意义(P>0.05)。术后中位随访时间为42.8个月(18～60个月),共3例FIGOⅡ期以上患者死亡。不同年龄组患者预后差异无统计学意义(P>0.05)。④≤40岁组患者中,有无症状组间的临床表现和预后相关指标间比较,差异均无统计学意义(P>0.05)。结论:LG-ESS发病年龄相对年轻,肿瘤常单发,直径较大,无特异性临床表现,发病时以早期病例多见,预后较好。临床上对40岁以下年轻无症状的子宫占位的患者应警惕LG-ESS的发生。
Objective:To investigate the difference of clinical manifestation,character of mass,clinical stage,prognosis between different age groups in low-grade endometrial stromal sarcoma(LG-ESS) patients.Methods:The clinical,pathological and follow-up data of the LG-ESS patients treated in the Department of Gynecology,West China Second University Hospital,Sichuan University from September 2010 to March 2015 were retrospectively analyzed.The difference of clinical manifestation and prognosis between different age groups[≤40 years old(29 cases) vs >40 years old(32 cases)] and between with(15 cases) and without(14 cases)clinical symptoms group in the younger patients(≤40 years old) were analyzed.Results:①The mean age of 61 cases was 39.61±9.47(rang 17-60)years old.47 cases(77.05%) were in the FIGO stage Ⅰ.②The proportion of no clinical symptoms(48.28% vs 15.63%),single tumor percentage(89.65% vs 59.37%),and maximum diameter of single tumor(6.84±2.20 cm vs 6.34±3.83 cm) between two groups were totally statistically different(P<0.05).③The difference of FIGO stage and prognosis was not significant(P>0.05).The median follow-up time was 42.8 months(range 18-60 months),and 3 cases in the FIGO more than stage Ⅱ died.④The difference of clinical manifestation and prognosis between with and without clinical symptoms group in the younger patients(≤40 years old) was not significant(P>0.05).Conclusions:The episode age of LG-ESS is relatively younge.The tumor is usually solitary,with larger diameter and no specific clinical manifestations.Early cases are common and five year survival rate is relatively high.As Compared to the patients over 40 years old,the single tumor and no-symptom portion were more common and the tumor size was bigger in the patients under 40 years old.
Objective:To investigate the difference of clinical manifestation,character of mass,clinical stage,prognosis between different age groups in low-grade endometrial stromal sarcoma(LG-ESS) patients.Methods:The clinical,pathological and follow-up data of the LG-ESS patients treated in the Department of Gynecology,West China Second University Hospital,Sichuan University from September 2010 to March 2015 were retrospectively analyzed.The difference of clinical manifestation and prognosis between different age groups[≤40 years old(29 cases) vs >40 years old(32 cases)] and between with(15 cases) and without(14 cases)clinical symptoms group in the younger patients(≤40 years old) were analyzed.Results:①The mean age of 61 cases was 39.61±9.47(rang 17-60)years old.47 cases(77.05%) were in the FIGO stage Ⅰ.②The proportion of no clinical symptoms(48.28% vs 15.63%),single tumor percentage(89.65% vs 59.37%),and maximum diameter of single tumor(6.84±2.20 cm vs 6.34±3.83 cm) between two groups were totally statistically different(P<0.05).③The difference of FIGO stage and prognosis was not significant(P>0.05).The median follow-up time was 42.8 months(range 18-60 months),and 3 cases in the FIGO more than stage Ⅱ died.④The difference of clinical manifestation and prognosis between with and without clinical symptoms group in the younger patients(≤40 years old) was not significant(P>0.05).Conclusions:The episode age of LG-ESS is relatively younge.The tumor is usually solitary,with larger diameter and no specific clinical manifestations.Early cases are common and five year survival rate is relatively high.As Compared to the patients over 40 years old,the single tumor and no-symptom portion were more common and the tumor size was bigger in the patients under 40 years old.
引文
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[8]Boll D,Verhoeven RH,Van der Aa MA,et al.Incidence and survival trends of uncommon corpus uteri malignancies in the Netherlands1989-2008[J].Int J Gynecol Cancer,2012,22(4):599-606.
[9]Choo KJ,Lee HJ,Lee TS,et al.Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic mocerllation[J].Obstet Gyneclo Sci,2015,58(5):414-417.
[10]Conklin CM,Longacre TA.Endometrial stromal tumors:the new WHOclassification[J].Adv Anat Pathol,2014,21(6):383-393.
[11]Vilos GA,Allaire C,Laberge PY,et al.The management of uterine leiomyomas[J].J Obstet Gynaecol Can,2015,37(2):157-178.
[12]子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科杂志,2017,52(12):793-800.
[13]Bhatla N,Denny L.FIGO cancer report 2018[J].Int J Gynaecol Obstet,2018,143(2):2-3.
[14]Koh WJ,Abu-Rustum NR,Bean S,et al.Uterine neoplasms,version1.2018,NCCN clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2018,16(2):170-199.
[15]Shah JP,Bryant CS,Kumar S,et al.Lymphadenectomy and ovarian preservation in low-grade endometrial stromal sarcoma[J].Obstet Gynecol,2008,112(5):1102-1108.
[16]Kilzieh R,Rakislova N,TornéA,et al.Endometrial stromal sarcoma arising in colotectal endometriosis[J].Int J Gynecol Pathol,2017,36(5):433-437.
[17]Lax SF.New features in the 2014 WHO classification of uterine neoplasms[J].Pathologe,2016,37(6):500-511.
[2]Mbatani PJ.Uterine sarcomas[J].Int J Gynaecol Obstet,2015,131(2):S105-S110.
[3]Oliva E,Carcangiu ML,Carinelli SG,et al.Mesenchymal tumors of the uterus.WHO classification of tumours of female reproduc-tive organs[M].4 th ed.Lyon,France:IARC Press,2014:135-147.
[4]FIGO,International Federation of Gynecology and Obstetrics.FIGOcancer report 2015[J].Int J Gynaecol Obstet,2015,131(2):S75.
[5]Arend R,Doneza JA,Wright JD.Uterine carcinosarcoma[J].Curr Opin Oncol,2011,23(5):531-536.
[6]Park GE,Rha SE,Oh SN,et al.Ultrasonographic findings of low-grade endometrial stromal sarcoma of the uterus with a focus on cystic de-generation[J].Ultrasonography,2016,35(2):124-130.
[7]Ladwig N,Garg K.Endometrial stromal neoplasms:updates in classification and common diagnostic dilemmas[J].AJSP,2016,21(2):73-81.
[8]Boll D,Verhoeven RH,Van der Aa MA,et al.Incidence and survival trends of uncommon corpus uteri malignancies in the Netherlands1989-2008[J].Int J Gynecol Cancer,2012,22(4):599-606.
[9]Choo KJ,Lee HJ,Lee TS,et al.Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic mocerllation[J].Obstet Gyneclo Sci,2015,58(5):414-417.
[10]Conklin CM,Longacre TA.Endometrial stromal tumors:the new WHOclassification[J].Adv Anat Pathol,2014,21(6):383-393.
[11]Vilos GA,Allaire C,Laberge PY,et al.The management of uterine leiomyomas[J].J Obstet Gynaecol Can,2015,37(2):157-178.
[12]子宫肌瘤的诊治中国专家共识专家组.子宫肌瘤的诊治中国专家共识[J].中华妇产科杂志,2017,52(12):793-800.
[13]Bhatla N,Denny L.FIGO cancer report 2018[J].Int J Gynaecol Obstet,2018,143(2):2-3.
[14]Koh WJ,Abu-Rustum NR,Bean S,et al.Uterine neoplasms,version1.2018,NCCN clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2018,16(2):170-199.
[15]Shah JP,Bryant CS,Kumar S,et al.Lymphadenectomy and ovarian preservation in low-grade endometrial stromal sarcoma[J].Obstet Gynecol,2008,112(5):1102-1108.
[16]Kilzieh R,Rakislova N,TornéA,et al.Endometrial stromal sarcoma arising in colotectal endometriosis[J].Int J Gynecol Pathol,2017,36(5):433-437.
[17]Lax SF.New features in the 2014 WHO classification of uterine neoplasms[J].Pathologe,2016,37(6):500-511.