子宫恶性混合性苗勒管肿瘤32例临床特征分析
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摘要
目的:分析子宫恶性混合性苗勒管肿瘤(MMMT)的临床特点、诊断、治疗及影响预后的相关因素。方法:回顾性分析西安交通大学第一附属医院2008年1月至2018年1月收治的32例子宫MMMT(1例子宫颈MMMT,31例子宫体MMMT)的临床资料,并对影响子宫MMMT的3年生存率的相关因素行Cox回归分析。结果:①患者平均年龄58.2±5.6岁,71.9%(23/32)为绝经后妇女。93.8%(30/32)表现为不规则阴道流血。77.8%(21/27)术前肿瘤标志物(NSE、CA_(125)、CA_(724)、CA_(199)等)有不同程度升高,多表现为轻度增高。②44.4%(12/27)术前诊断性刮宫病理检查结果与术后病理学诊断相符。93.3%(14/15)的盆腔MRI检查可实现术前早期诊断。③所有患者均行手术治疗,术后26例行化疗,3例接受放疗。④随访6～125个月。子宫体MMMTⅠ期患者1、3、5年总生存率分别为95.3%、61.9%、42.9%,Ⅱ、Ⅲ、Ⅳ期患者1、3、5年总生存率分别为80.0%、50.0%、30.0%。⑤Cox多因素分析示,肿瘤浸润子宫肌层深度≥1/2是影响生存的独立危险因素(OR 5.102,P=0.018)。结论:子宫MMMT多发生于绝经后妇女,预后差,临床表现多为阴道不规则流血,实验室检查肿瘤标志物轻度升高无特异性,术前行盆腔MRI检查联合诊刮可提高术前诊断率,早期及晚期患者5年生存率均低于50%,且肿瘤浸润子宫肌层深度≥1/2是影响生存的独立危险因素。
Objective:To analyze the clinical characteristics,diagnosis,treatment and prognostic factors of Uterine malignant Mullerian mixed tumor(MMMT).Methods:The clinical data of 32 cases of MMMT(1 case of cervical MMMT and 31 cases of uterine body MMMT) admitted in the First Affiliated Hospital of Xi′an Jiaotong University from January 2008 to January 2018 were retrospectively analyzed.The Cox regression analysis was performed on the related factors affecting the 3-year survival rate of MMMT.Results:①The mean age of patients was 58.2±5.6 years old.71.9%(23/32) were postmenopausal women.93.8%(30/32) showed irregular vaginal bleeding.77.8%(21/27)were with increased preoperative tumor markers(NSE,CA_(125),CA_(724),CA_(199),etc.),mostly with slight increase.②The diagnostic curettage pathological results before the operation was consistent with the postoperative pathological diagnosis in 44.4% of patients(12/27).93.3%(14/15) could be diagnosed by pelvic MRI preoperatively.③All patients received surgical treatment.26 patients received chemotherapy and 3 patients received radiotherapy after surgery.④Postoperative follow-up lasted 6-125 months.The 1,3,5 year overall survival rates were 95.3%,61.9%,42.9% in patients with stage Ⅰ uterine body MMMT,respectively.The 1,3,5 year overall survival rates of patients with stage Ⅱ/Ⅲ/Ⅳ were 80.0%、50.0%、30.0%,respectively.⑤Cox multivariate analysis indicated that tumor infiltration depth of myometrium more than 1/2 was an independent risk factors of survival rate(OR 5.102,P=0.018).Conclusions:MMMT often occurs in postmenopausal women with poor prognosis.The most common clinical manifestation is irregular vaginal bleeding.There is no specific laboratory examination with only a few tumor markers slightly elevated.Preoperatively pelvic MRI combined with curettage diagnosis could improve the preoperative diagnostic rate.5 year survival rate in both early or late stage was lower than 50%.The tumor infiltration depth of myometrium more than 1/2 was an independent risk factor affecting survival rate.
Objective:To analyze the clinical characteristics,diagnosis,treatment and prognostic factors of Uterine malignant Mullerian mixed tumor(MMMT).Methods:The clinical data of 32 cases of MMMT(1 case of cervical MMMT and 31 cases of uterine body MMMT) admitted in the First Affiliated Hospital of Xi′an Jiaotong University from January 2008 to January 2018 were retrospectively analyzed.The Cox regression analysis was performed on the related factors affecting the 3-year survival rate of MMMT.Results:①The mean age of patients was 58.2±5.6 years old.71.9%(23/32) were postmenopausal women.93.8%(30/32) showed irregular vaginal bleeding.77.8%(21/27)were with increased preoperative tumor markers(NSE,CA_(125),CA_(724),CA_(199),etc.),mostly with slight increase.②The diagnostic curettage pathological results before the operation was consistent with the postoperative pathological diagnosis in 44.4% of patients(12/27).93.3%(14/15) could be diagnosed by pelvic MRI preoperatively.③All patients received surgical treatment.26 patients received chemotherapy and 3 patients received radiotherapy after surgery.④Postoperative follow-up lasted 6-125 months.The 1,3,5 year overall survival rates were 95.3%,61.9%,42.9% in patients with stage Ⅰ uterine body MMMT,respectively.The 1,3,5 year overall survival rates of patients with stage Ⅱ/Ⅲ/Ⅳ were 80.0%、50.0%、30.0%,respectively.⑤Cox multivariate analysis indicated that tumor infiltration depth of myometrium more than 1/2 was an independent risk factors of survival rate(OR 5.102,P=0.018).Conclusions:MMMT often occurs in postmenopausal women with poor prognosis.The most common clinical manifestation is irregular vaginal bleeding.There is no specific laboratory examination with only a few tumor markers slightly elevated.Preoperatively pelvic MRI combined with curettage diagnosis could improve the preoperative diagnostic rate.5 year survival rate in both early or late stage was lower than 50%.The tumor infiltration depth of myometrium more than 1/2 was an independent risk factor affecting survival rate.
引文
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[17] Ross MS,Elishaev E,Berger JL.Prognostic significance of omental disease and the role of omental sampling in patients with uterine carcinosarcoma[J].Int J Gynecol Cancer,2018,28(2):254-259.
[18] 雒永刚.子宫癌肉瘤临床病理及预后影响因素分析[J].世界最新医学信息文摘,2018,18(45):160-161.
[19] Gungorduk K,Ozdemir A,Ertas IE,et al.Adjuvant treatment modalities,prognostic predictors and outcomes of uterine carcinosarcomas[J].Cancer Res Treat,2015,47(2):282-289.
[20] Gokce ZK,Turan T,Karalok A,et al.Clinical outcomes of uterine carcinosarcoma results of 94 patients[J].Int J Gynecol Cancer,2015,25(2):279-287.
[21] ?ükür YE,Ta?k?n S,Varl? B.Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma[J].Int J Clin Oncol,2018,23(1):114-120.
[2] Bhoil A,Kashyap R,Bhattacharya A.F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a rare case of recurrent malignant mixed mullerian tumor[J].World J Nucl Med,2014,13:64-66.
[3] 马丁,沈铿,崔恒 主编.常见妇科恶性肿瘤诊治指南[M].5版.北京:人民卫生出版社,2016:71-79.
[4] Lax SF.New features in the 2014 WHO classification of uterine neoplasms[J].Pathologe,2016,37(6):500-511.
[5] 孙建衡,蔡树模,高永良主编.妇科肿瘤学[M].北京:北京大学医学出版社,2011:783-797.
[6] Lopez-Garcia MA,Palacios J.Pathologic and molecular features of uterine carcinosarcomas[J].Semin Diagn Pathol,2010,27(4):274-286.
[7] De Jong RA,Nijman HW,Wijbrandi TF,et al.Molecular markers and clinical behavior of uterine carcinosarcomas:focus on the epithelial tumor component[J].Mod Pathol,2011,24(2):1368-1379.
[8] El-Nashar SA,Mariani A.Uterine carcinosarcoma[J].Clin Obstet Gynecol,2011,54(2):292-304.
[9] 欧阳婧,李小毛.术前病理联合血清CA125诊断子宫癌肉瘤的价值[J].广东医学,2015,36(8):1210-1212.
[10] D′Angelo E,Prat J.Uterine sarcomas:a review[J].Gynecol Oncol,2010,116(1):131-139.
[11] Takeuchi M,Matsuzaki K,Harada M.Carcinosarcoma of the uterus:MRI findings including diffusion-weighted imaging and MR spectroscopy[J].Acta Radiol,2016,57(10):1277-1284.
[12] Huang YT,Chang CB,Yeh CJ.3 Diagnostic accuracy of 3.0 T diffusion-weighted MRI for patients with uterine carcinosarcoma:assessment of tumor extent and lymphatic metastasis[J].J Magn Reson Imaging,2018,2(3):13-15.
[13] Nemani D,Mitra N,Guo M,et al.Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma:a SEER analysis[J].Gynecol Oncol,2008,111(1):82-88.
[14] 欧阳婧,李小毛,杨晓辉.淋巴结切除术在子宫癌肉瘤治疗中的价值[J].中国现代手术学杂志,2016,20(4):241-245.
[15] Schick U,Bolukbasi Y,Thariat J,et al.Vees H Outcome and prognostic factors in endometrial stromal tumors:a Rare Cancer Network study[J].Int J Radiat Oncol Biol Phys,2012,82(5):e757-e763.
[16] Luz R,Ferreira J,Rocha M.Uterine carcinosarcoma:clinicopathological features and prognostic factors[J].Acta Med Port,2016,29(10):621-628.
[17] Ross MS,Elishaev E,Berger JL.Prognostic significance of omental disease and the role of omental sampling in patients with uterine carcinosarcoma[J].Int J Gynecol Cancer,2018,28(2):254-259.
[18] 雒永刚.子宫癌肉瘤临床病理及预后影响因素分析[J].世界最新医学信息文摘,2018,18(45):160-161.
[19] Gungorduk K,Ozdemir A,Ertas IE,et al.Adjuvant treatment modalities,prognostic predictors and outcomes of uterine carcinosarcomas[J].Cancer Res Treat,2015,47(2):282-289.
[20] Gokce ZK,Turan T,Karalok A,et al.Clinical outcomes of uterine carcinosarcoma results of 94 patients[J].Int J Gynecol Cancer,2015,25(2):279-287.
[21] ?ükür YE,Ta?k?n S,Varl? B.Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma[J].Int J Clin Oncol,2018,23(1):114-120.