Outcome and prognosis in uterine sarcoma and malignant mixed Mullerian tumor
Outcome and prognosis in uterine sarcoma and malignant mixed Mullerian tumor
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DOI：
10.1007/s00404-015-3993-6
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发表时间：
2016-08-01
影响因子：
2.6
通讯作者：
Thiel, Falk C.
中科院分区：
文献类型：
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作者：
Burghaus, Stefanie;Halmen, Sonja;Thiel, Falk C.
关于子宫肉瘤和恶性苗勒管混合瘤（MMMT）患者的最佳治疗方法的证据很少。本研究回顾了143例低级别子宫内膜间质肉瘤（ESS）、平滑肌肉瘤（LMS）和高级别（未分化）子宫内膜肉瘤（UES）和MMMT患者的临床治疗和预后。收集并分析所有可用的临床和病理学数据。采用考克斯比例风险比模型对可能的预后因素进行多因素分析，计算生存数据，ESS、LMS、UES和MMMT患者的5年总生存率有显著差异（86 vs. 40 vs. 57 vs. 45%; P < 0.001）。多因素分析显示，患者的年龄、较高的FIGO分期（III-IV）、吸烟史、既往盆腔放疗、糖尿病和手术后残留肿瘤与总体生存率较差相关。LMS（HR 4.68; 95% CI 1.35-16.17）、UES（HR 1.21; 95% CI 0.26-5.77）和MMMT（HR 1.63; 95% CI 0.42-6.43）的组织学亚型也与比ESS更差的总生存率相关（P = 0.008）。辅助治疗与总生存率没有相关性，目前为止辅助治疗对总生存率没有任何益处，因此重点放在初次手术上。在未来的研究中，实体应单独调查有关的预后因素和有效的治疗管理。
There is low evidence regarding the optimal treatment in patients with uterine sarcomas and malignant mixed Mullerian tumors (MMMTs). This study provides an overview of experience at our center with patients diagnosed with uterine sarcoma and MMMT, in relation to the clinical management and outcome.The medical records for 143 patients with low-grade endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and high-grade (undifferentiated) endometrial sarcoma (UES) and MMMT were reviewed. All available clinical and pathological data were collected and analyzed. Putative prognostic factors were entered into a multivariate analysis using a Cox proportional hazards ratio model, and survival data were calculated.The 5-year overall survival rates were significantly different between patients with ESS, LMS, and UES and MMMT (86 vs. 40 vs. 57 vs. 45 %; P < 0.001). The multivariate analysis showed that the patients' age, higher FIGO stage (III-IV), a history of smoking, prior pelvic radiation, diabetes, and residual tumor after surgery were associated with a poorer overall survival. Histological subtypes of LMS (HR 4.68; 95 % CI 1.35-16.17), UES (HR 1.21; 95 % CI 0.26-5.77) and MMMT (HR 1.63; 95 % CI 0.42-6.43) were also associated with a poorer overall survival than ESS (P = 0.008). Adjuvant therapies showed no associations with overall survival.Adjuvant therapy has so far not shown any overall survival benefit, and the focus is therefore on primary surgery. In future studies, the entities should be investigated separately in relation to prognostic factors and effective therapeutic management.