Retrospective Cohort Study Evaluating the Impact of Intraperitoneal Morcellation on Outcomes of Localized Uterine Leiomyosarcoma
Retrospective Cohort Study Evaluating the Impact of Intraperitoneal Morcellation on Outcomes of Localized Uterine Leiomyosarcoma
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DOI：
10.1002/cncr.28844
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发表时间：
2014-10-15
期刊：
影响因子：
6.2
通讯作者：
Muto, Michael G.
中科院分区：
文献类型：
--
作者：
George, Suzanne;Barysauskas, Constance;Muto, Michael G.
背景：子宫平滑肌肉瘤（ULMS）在子宫切除术标本中的发生率为0.1%-0.2%。迄今为止，还没有一种术前技术能可靠地鉴别ULMS和子宫肌瘤。越来越多地使用微创方法治疗平滑肌瘤可能会导致ULMS不经意间粉碎，导致肿瘤腹膜内扩散。本研究的目的是评估腹膜内粉碎术对ULMS患者结局的影响。方法：在这项回顾性队列研究中，回顾了2007年至2012年在作者所在机构就诊的所有ULMS患者。比较了首次手术治疗子宫局限性ULMS的患者的人口统计学资料和结局，这些患者接受了分碎术或腹式全子宫切除术（TAH）。结果：共确定了58例患者，包括39例接受TAH的患者和19例接受腹膜内粉碎术的患者。腹膜内分碎术与腹部/盆腔复发风险显著增加（P= 0.001）和中位无复发生存期显著缩短（10.8个月vs 39.6个月; P= 0.002）相关。多变量校正模型显示，与粉碎相关的复发风险增加> 3倍（风险比，3.18; 95%置信区间，1.5-6.8; P=.003）。结论：腹膜内粉碎性子宫平滑肌瘤可能影响ULMS患者的预后。由于没有可靠的术前技术来区分ULMS和良性平滑肌瘤，应尽一切努力尽量减少腹腔内子宫粉碎。[见本期第000-000页的社论。] (C)2014年美国癌症协会
BACKGROUND: Uterine leiomyosarcoma (ULMS) is identified in 0.1% to 0.2% of hysterectomy specimens of presumed leiomyoma. To date, there is no preoperative technique that reliably differentiates ULMS from uterine leiomyoma. Increasing use of minimally invasive approaches for the management of leiomyomas may result in inadvertently morcellated ULMS with resultant intraperitoneal dissemination of tumor. The objective of this study was to assess the impact of intraperitoneal morcellation on the outcomes of patients with ULMS. METHODS: In this retrospective cohort study, all patients with ULMS who attended the authors' institutions from 2007 to 2012 were reviewed. Demographics and outcomes were compared between those who underwent morcellation or total abdominal hysterectomy (TAH) as their first surgery for uterus-limited ULMS. RESULTS: In total, 58 patients were identified, including 39 who underwent TAH and 19 who underwent intraperitoneal morcellation. Intraperitoneal morcellation was associated with a significantly increased risk of abdominal/pelvic recurrences (P=.001) and with significantly shorter median recurrence-free survival (10.8 months vs 39.6 months; P=.002). A multivariate adjusted model demonstrated a > 3 times increased risk of recurrence associated with morcellation (hazard ratio, 3.18; 95% confidence interval, 1.5-6.8; P=.003). CONCLUSIONS: Intraperitoneal morcellation of presumed leiomyoma worsens the outcomes of women with ULMS. Because there are no reliable preoperative techniques to distinguish ULMS from benign leiomyoma, all efforts to minimize intraperitoneal uterine morcellation should be considered. [ See editorial on pages 000-000, this issue.] (C) 2014 American Cancer Society.