The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma
The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma
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DOI：
10.1016/j.ygyno.2011.04.021
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发表时间：
2011-08-01
影响因子：
4.7
通讯作者：
Nam, Joo-Hyun
中科院分区：
文献类型：
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作者：
Park, Jeong-Yeol;Park, Sun-Kyung;Nam, Joo-Hyun
Objective.子宫平滑肌肉瘤（LMS）通常是在子宫平滑肌瘤手术后诊断出来的，因此经常发生肿瘤分碎。我们评估了手术中肿瘤粉碎对明显早期子宫LMS患者预后的影响。回顾性比较了行腹式全子宫切除术而不进行肿瘤粉碎术的患者与行包括腹式、阴道式或腹腔镜肿瘤粉碎术的患者的结局。我们评估了1989年至2010年间56例II期子宫LMS患者，其中25例有肿瘤分碎，31例无肿瘤分碎。两组间在年龄、产次、绝经状态、体重指数、分期、核分裂计数、肿瘤分级、淋巴结清扫、辅助治疗和随访时间方面无显著差异。然而，肿瘤大小明显更小（9.8 cm vs. 7.3 cm，P = 0.022），卵巢组织在肿瘤分碎患者中更常被保留（38.7% vs. 72%，P = 0.013）。在单变量分析中，只有肿瘤粉碎与较差的无病生存期（DFS）显著相关（比值比[OR] 2.59; 95%置信区间[CI]，1.03-6.50; P = 0.043），以及更高分期（I vs.（OR，19.12; 95% CI，1.19-307.11; P = 0.037））和肿瘤粉碎（OR，3.07; 95% CI，1.05-8.93; P = 0.040）与总生存期（OS）较差显著相关。在多变量分析中，（OR，20.34; 95% CI，1.27-325.58; P = 0.033）和肿瘤粉碎（OR，3.11; 95% CI，1.07-9.06：P = 0.038）与较差的OS显著相关。腹盆腔播散患者的百分比，如腹膜肉瘤病或阴道尖复发所示，肿瘤粉碎组的阳性率（44%）明显高于无粉碎组（12.9%）（P = 0.032）。在明显早期子宫LMS患者中，手术中肿瘤粉碎增加了腹盆播散率，并对DFS和OS产生不利影响。(C)2011 Elsevier Inc. All rights reserved.
Objective. Uterine leiomyosarcoma (LMS) is usually diagnosed after surgery for leionayoma; thus tumor morcellation frequently occurs. We evaluated the impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine LMS.Methods. Outcomes were retrospectively compared between patients who underwent total abdominal hysterectomy without tumor morcellation and those who underwent surgery that included abdominal, vaginal or laparoscopic tumor morcellation.Results. We assessed 56 consecutive patients with stage land II uterine LMS between 1989 and 2010,25 with and 31 without tumor morcellation. There were no significant between group differences in age, parity, menopausal status, body mass index, stage, mitotic count, tumor grade, lymph node dissection, adjuvant therapy, and follow-up duration. However, tumor size was significantly smaller (9.8 cm vs. 7.3 cm, P = 0.022) and ovarian tissue was more frequently preserved (38.7% vs. 72%, P = 0.013) in patients with tumor morcellation. In univariate analysis, only tumor morcellation was significantly associated with poorer disease-free survival (DFS) (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.03-6.50; P = 0.043), and higher stage (I vs. (OR, 19.12; 95% Cl, 1.19-307.11; P = 0.037)) and tumor morcellation (OR, 3.07; 95% CI, 1.05-8.93; P = 0.040) were significantly associated with poorer overall survival (OS). In multivariate analysis, higher stage (OR, 20.34; 95% Cl, 1.27-325.58; P = 0.033) and tumor morcellation (OR, 3.11; 95% CI, 1.07-9.06: P = 0.038) were significantly associated with poorer OS. The percentage of patients with abdomino-pelvic dissemination, as shown by peritoneal sarcomatosis or vaginal apex recurrence, was significantly greater in patients with than without tumor morcellation (44% vs. 12.9%, P = 0.032).Conclusion. Tumor morcellation during surgery increased the rate of abdomino-pelvic dissemination and adversely affected DFS and OS in patients with apparently early uterine LMS. (C) 2011 Elsevier Inc. All rights reserved.