Abstract：
Background: This study aimed to systematically review the existing literature on uterine smooth muscle tumor of uncertain malignant potential (STUMP) to provide information about characteristics and outcomes of patients and the risk factors for recurrence over a period of 60 years (1960−2021). Methods: According to PRISMA guidelines, we searched for \"uterine smooth muscle tumor of uncertain malignant potential\" in PubMed (all fields) and Scopus (Title/Abstract/Keywords) databases (accessed on 1 January 2022). Relevant articles were obtained in full-text format and screened for additional references. The only filter used was the English language. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: Thirty-four studies, including 189 cases, were included. The median age was 43 years, and in 21.5% of cases there was a recurrence of the disease. Bivariate analysis showed a significant association between use of morcellation without bag and risk of recurrence (p = 0.001). Unprotected morcellation during demolitive or conservative surgery was independently associated with a higher risk of disease recurrence with a relative risk of 2.94 (p < 0.001). A significant progressive decrease in the recurrence rate was observed over time (r = −0.671, p = 0.008). The percentage of patients who underwent surgery followed by in-bag protected morcellation significantly increased after the publication of the U.S. Food and Drug Administration alert about the risk linked to this procedure (p = 0.01). Conclusions: Unprotected morcellation of the lesion is associated with the relapse of the disease. However, this clinical condition showed a drastic decrease over time. This could likely be due to the increased awareness by surgeons of the importance of customizing surgical treatment.
摘要：
背景：本研究旨在系统回顾有关恶性潜能不确定的子宫平滑肌肿瘤（STUMP）的现有文献，以提供有关60年（1960-2021年）期间患者的特征和结局以及复发的危险因素的信息。方法：根据PRISMA指南，我们在PubMed(所有领域)和Scopus(标题/摘要/关键词)数据库(2022年1月1日访问)中搜索了"不确定恶性潜能的子宫平滑肌肿瘤".以全文格式获得了相关文章，并筛选了其他参考文献。唯一使用的过滤器是英语。包括符合Stanford标准的组织病理学诊断为STUMP的患者的完整病例描述。结果：34项研究，包括189例，包括在内。中位年龄为43岁,在21.5％的病例中，该疾病复发。双变量分析显示，使用无袋碎裂与复发风险之间存在显着关联（p=0.001）。在摘除或保守性手术中，无保护的碎裂与较高的疾病复发风险独立相关，相对风险为2.94(p<0.001)。随着时间的推移，观察到复发率显着逐渐降低（r=-0.671，p=0.008）。在美国食品和药物管理局发布关于与该程序相关的风险的警报后，接受手术后进行袋中保护碎裂的患者百分比显着增加（p=0.01）。结论：病变的无保护碎裂与疾病的复发有关。然而,随着时间的推移，这种临床状况急剧减少。这可能是由于外科医生对定制手术治疗的重要性的认识增加。
