37例子宫肉瘤患者的临床特点分析及预后
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摘要
目的 回顾性分析子宫肉瘤患者的临床病理资料及随访资料,了解子宫肉瘤发病和病理类型的相关因素,以及子宫肉瘤的预后影响因素。方法 收集2011年7月至2018年7月期间大连市中心医院妇科的收治37例子宫肉瘤患者的临床病理资料,其中子宫腺肉瘤(AS)3例,子宫平滑肌肉瘤(LMS)10例,子宫癌肉瘤(CS)11例,子宫内膜间质肉瘤(ESS)13例。统计患者年龄、临床症状、术前肿物大小、CA125值、临床分期、治疗方式、术后病理等资料,并对所有未在住院期间死亡患者进行电话随访,随访终止日期为2018年12月30日。应用SPSS21.0对数据进行统计分析影响预后的相关因素。结果 对子宫肉瘤患者预后影响因素进行单因素分析显示:术前CA125>35 (P=0.005)、FIGO分期(P=0.000)、淋巴结转移(P=0.001)、组织学分级(P=0.019)是影响子宫肉瘤患者生存时间的相关因素。Cox多因素分析:术前CA125>35(OR=1.655, 95%CI 1.067-2.568,P=0.023)、FIGO分期高(OR=2.433, 95%CI 1.104-5.360,P=0.018)、淋巴结转移阳性(OR=1.242, 95%CI 1.007-1.532,P=0.016)是影响子宫肉瘤预后的独立因素。结论 术前CA125>35、术后淋巴结阳性、FIGO分期高、组织分化程度越差,患者中位生存时间越短,而术前CA125>35、术后淋巴结阳性、FIGO分期高是影响子宫肉瘤预后的独立因素。
Objective To investigate the incidence, pathological types and prognostic factors of uterine sarcoma. Methods The clinical and pathological data of 37 cases of uterine sarcoma treated in Dalian Central hospital from July 2011 to July 2018 were collected and the follow-up data were recorded. Among them, 3 cases were adenosarcoma(AS), 10 cases were leiomyosarcoma(LMS), 11 cases were carcinosarcoma(CS) and 13 cases were endometrial stromal sarcoma(ESS). The data of age, clinical symptoms, sizes of preoperative tumors, CA125 value, clinical stage, treatment and pathology were collected. All survival patients were followed up by telephone until December 30, 2018. SPSS21.0 was used to analyze the prognostic factors. Results Univariate analysis revealed that preoperative CA125>35(P=0.005), FIGO staging(P=0.000), lymph node metastasis(P=0.001), and histological grade(P=0.019) were the factors affecting the survival time of patients with uterine sarcoma. Cox multivariate analysis revealed that preoperative CA125(P=0.023), FIGO clinical stage(P=0.018) and lymph node metastasis(P=0.016) were independent factors affecting the prognosis of uterine sarcoma. Conclusion The higher the preoperative CA125, the more positive the lymph node, the later the FIGO staging and the worse the degree of tissue differentiation, the shorter the median survival time. Preoperative CA125>35, FIGO stage and lymph node metastasis are independent factors affecting the prognosis of uterine sarcoma.
Objective To investigate the incidence, pathological types and prognostic factors of uterine sarcoma. Methods The clinical and pathological data of 37 cases of uterine sarcoma treated in Dalian Central hospital from July 2011 to July 2018 were collected and the follow-up data were recorded. Among them, 3 cases were adenosarcoma(AS), 10 cases were leiomyosarcoma(LMS), 11 cases were carcinosarcoma(CS) and 13 cases were endometrial stromal sarcoma(ESS). The data of age, clinical symptoms, sizes of preoperative tumors, CA125 value, clinical stage, treatment and pathology were collected. All survival patients were followed up by telephone until December 30, 2018. SPSS21.0 was used to analyze the prognostic factors. Results Univariate analysis revealed that preoperative CA125>35(P=0.005), FIGO staging(P=0.000), lymph node metastasis(P=0.001), and histological grade(P=0.019) were the factors affecting the survival time of patients with uterine sarcoma. Cox multivariate analysis revealed that preoperative CA125(P=0.023), FIGO clinical stage(P=0.018) and lymph node metastasis(P=0.016) were independent factors affecting the prognosis of uterine sarcoma. Conclusion The higher the preoperative CA125, the more positive the lymph node, the later the FIGO staging and the worse the degree of tissue differentiation, the shorter the median survival time. Preoperative CA125>35, FIGO stage and lymph node metastasis are independent factors affecting the prognosis of uterine sarcoma.
引文
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[3] Nasioudis D,Chapman-Davis E,Frey M,et al.Safety of ovarian preservation in premenopausal women with stage I uterine sarcoma[J].J Gynecol Oncol,2017,28(4):e46.
[4] Leitao MM,Sonoda Y,Brennan MF,et al.Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus[J].Gynecol Oncol,2003,91(1):209-212.
[5] Leung F,Terzibachian JJ.The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma[J].Gynecol Oncol,2012,124(1):172-173.
[6] Park JY,Kim DY,Kim JH,et al.The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus[J].Ann Surg Oncol,2011,17(18):3453-3461.
[7] Carroll A,Ramirez PT,Westin SN,et al.Uterine adenosarcoma:An analysis on management,outcomes,and risk factors for recurrence[J].Gynecol Oncol,2014,135(3):455-461.
[8] Tasci T,Karalok A,Taskin S,et al.Does Lymphadenectomy Improve Survival in Uterine Leiomyosarcoma?[J].Int J Gynecol Cancer,2015,25(6):1031-1036.
[9] Potikul C,Tangjitgamol S,Khunnarong J,et al.Uterine Sarcoma:Clinical Presentation,Treatment and Suivival Outcomes in Thailand [J].Asian Pac J Cancer Prev,2016,17(4):1759-1767.
[10] Benson C,Miah AB.Miah.Uterine sarcoma-current perspectives[J].Int J Women's Health,2017,9:597-606.
[11] Nassar OA,Moaty BE,Khalil ES,et al.Outcome and prognostic factors of uterine sarcoma in 59 patients:single institutional results[J].J Egypt Natl Canc Inst,2010,22(2):113-122.
[12] Hosh M,Antar S,Nazzal A,et al.Uterine Sarcoma:Analysis of 13,089 Cases Based on Surveillance,Epidemiology,and End Results Database[J].Int J Gynecol Cancer,2016,26(6):1098-1104.
[13] 王玲.113例子宫肉瘤临床病例分析[D].杭州:浙江大学,2018.
[14] 邢娟.43例子宫肉瘤的临床分析[D].合肥:安徽医科大学,2018.
[2] Abeler VM,R?yne O,Thoresen S,et al.Uterine sarcomas in Norway.A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients[J].Histopathology,2009,54(3):355-364.
[3] Nasioudis D,Chapman-Davis E,Frey M,et al.Safety of ovarian preservation in premenopausal women with stage I uterine sarcoma[J].J Gynecol Oncol,2017,28(4):e46.
[4] Leitao MM,Sonoda Y,Brennan MF,et al.Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus[J].Gynecol Oncol,2003,91(1):209-212.
[5] Leung F,Terzibachian JJ.The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma[J].Gynecol Oncol,2012,124(1):172-173.
[6] Park JY,Kim DY,Kim JH,et al.The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus[J].Ann Surg Oncol,2011,17(18):3453-3461.
[7] Carroll A,Ramirez PT,Westin SN,et al.Uterine adenosarcoma:An analysis on management,outcomes,and risk factors for recurrence[J].Gynecol Oncol,2014,135(3):455-461.
[8] Tasci T,Karalok A,Taskin S,et al.Does Lymphadenectomy Improve Survival in Uterine Leiomyosarcoma?[J].Int J Gynecol Cancer,2015,25(6):1031-1036.
[9] Potikul C,Tangjitgamol S,Khunnarong J,et al.Uterine Sarcoma:Clinical Presentation,Treatment and Suivival Outcomes in Thailand [J].Asian Pac J Cancer Prev,2016,17(4):1759-1767.
[10] Benson C,Miah AB.Miah.Uterine sarcoma-current perspectives[J].Int J Women's Health,2017,9:597-606.
[11] Nassar OA,Moaty BE,Khalil ES,et al.Outcome and prognostic factors of uterine sarcoma in 59 patients:single institutional results[J].J Egypt Natl Canc Inst,2010,22(2):113-122.
[12] Hosh M,Antar S,Nazzal A,et al.Uterine Sarcoma:Analysis of 13,089 Cases Based on Surveillance,Epidemiology,and End Results Database[J].Int J Gynecol Cancer,2016,26(6):1098-1104.
[13] 王玲.113例子宫肉瘤临床病例分析[D].杭州:浙江大学,2018.
[14] 邢娟.43例子宫肉瘤的临床分析[D].合肥:安徽医科大学,2018.