Uterine leiomyosarcoma: Analysis of treatment failures and survival
Uterine leiomyosarcoma: Analysis of treatment failures and survival
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DOI：
10.1006/gyno.1996.0185
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发表时间：
1996-07-01
影响因子：
4.7
通讯作者：
Cristofani, R
中科院分区：
文献类型：
--
作者：
Gadducci, A;Landoni, F;Cristofani, R
这项回顾性多中心研究的目的是评估 126 名子宫平滑肌肉瘤患者的复发率、时间和部位。手术是所有患者的初始治疗。幸存者的中位随访时间为 50 个月（范围为 3-168 个月），在 90 名 I-II 期疾病患者中，26 名接受术后放疗和/或化疗，35 名（38.9%）患者在中位时间 16 个月（范围为 2-102 个月）后出现疾病复发。 5 例 (14.3%) 患者出现盆腔复发，23 例 (65.7%) 患者出现远处复发，7 例 (20.0%) 患者出现盆腔加远处复发。接受辅助治疗和未接受辅助治疗的患者的总体复发率相似。接受盆腔照射的 15 名患者均未出现局部复发，但其中 5 名患者远处转移失败。 16例III期平滑肌肉瘤患者中，2例术后1个月内因并发疾病死亡，11例接受术后放疗和/或化疗。 13 名患者在中位时间 8 个月（范围：1-21 个月）后出现肿瘤复发。 3 名患者出现盆腔复发，4 名患者出现远处复发，6 名患者出现盆腔加远处复发。在 20 例 IV 期平滑肌肉瘤患者中，术后 6 例临床无疾病（A 组），14 例有临床可评估的残留病灶（B 组）。 A组中有3例患者接受术后放疗和/或化疗。 5 名患者在中位时间 11 个月（范围 8-16 个月）后出现疾病复发。 3 名患者出现远处复发，2 名患者出现盆腔加远处复发。B 组中有 11 名患者接受了术后化疗。 11 名患者在中位时间 6 个月（范围为 1-15 个月）后死亡，3 名患者分别在手术后 4、5 和 8 个月后仍然活着，并有疾病的临床证据。 Cox模型显示分期（P = 0.0001）、有丝分裂计数（P = 0.0002）和年龄（P = 0.0048）是无病生存的独立预后变量。总之，子宫平滑肌肉瘤具有侵袭性的临床行为，有局部复发和远处复发的倾向，肿瘤分期是最强的预后变量，只有早期疾病的患者才有生存的机会，而晚期或复发性疾病患者的治疗是姑息性的。 (C) 1996 学术出版社
The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 126 patients with uterine leiomyosarcomas. Surgery was the initial therapy for all patients. Median follow-up of survivors was 50 months (range, 3-168 months), Of the 90 patients with stage I-II disease, 26 received postoperative irradiation and/or chemotherapy, Thirty-five (38.9%) patients developed recurrent disease after a median time of 16 months (range, 2-102 months). Recurrence was pelvic in 5 (14.3%) patients, distant in 23 (65.7%), and pelvic plus distant in 7 (20.0%). The overall recurrence rate was similar in patients who received adjuvant treatment and in those who did not. None of the 15 patients who underwent pelvic irradiation developed local recurrences, but 5 of them failed in distant sites. Of the 16 patients with stage III leiomyosarcomas, 2 died of intercurrent disease within 1 month from surgery and 11 received postoperative irradiation and/or chemotherapy. Thirteen patients developed recurrent tumor after a median time of 8 months (range, 1-21 months). Recurrence was pelvic in 3, distant in 4, and pelvic plus distant in 6 patients. Of the 20 patients with stage IV leiomyosarcomas, after surgery 6 were clinically free of disease (group A) and 14 had clinically evaluable residual disease (group B). With regard to group A, 3 patients received postoperative irradiation and/or chemotherapy. Five patients developed recurrent disease after a median time of 11 months (range, 8-16 months). Recurrence was distant in 3 patients and pelvic plus distant in 2. With regard to group B, 11 patients underwent postoperative chemotherapy. Eleven patients died after a median time of 6 months (range, 1-15 months), and 3 are still alive with clinical evidence of disease after 4, 5, and 8 months, respectively, from surgery. Cox model showed that stage (P = 0.0001), mitotic count (P = 0.0002), and age (P = 0.0048) were independent prognostic variables for disease-free survival. In conclusion, uterine leiomyosarcomas have an aggressive clinical behavior, with a propensity to recur both locally and moreover at distant sites, Tumor stage is the strongest prognostic variable, Only patients with early-stage disease have a chance of surviving, whereas the treatment of patients with advanced or recurrent disease is palliative. (C) 1996 Academic Press, Inc.