背景:子宫肉瘤是一种罕见且异质性的妇科恶性肿瘤,其特征是进展迅速,预后不良。本研究旨在探讨中国子宫肉瘤患者的临床病理特征与预后的关系。
方法:在这项单中心回顾性研究中,我们回顾了2011年至2020年在西安交通大学第一附属医院接受治疗的75例经组织学证实的子宫肉瘤患者的病历.关于临床特征的信息,治疗,收集病理学和生存率。无进展生存期(PFS)和总生存期(OS)在Kaplan-Meier曲线中可视化。使用单变量分析的对数秩检验和多变量分析的Cox比例风险回归模型确定预后因素。
结果:组织病理学类型包括36个子宫内膜间质肉瘤(ESS,48%),33平滑肌肉瘤(LMS,44%)和6个腺肉瘤(8%)。诊断时的平均年龄为50.2±10.7岁。第一阶段和低档占大多数。在最后一次随访中,有26例复发和25例死亡。平均PFS和OS分别为89.41(95%CI:76.07-102.75)和94.03(95%CI:81.67-106.38)个月,分别。单因素分析表明,>50年,绝经后,高级阶段,≥1/2子宫肌层浸润,淋巴管间隙侵犯和高级别与较短的生存期有关(P<0.05)。彩色多普勒血流显像阳性信号与LMS组PFS较短相关(P=0.046)。ESS组的PFS长于LMS组(99.56vs.76.05个月,P=0.043)。多因素分析显示,绝经后和晚期是总队列和LMS组PFS和OS的独立危险因素。在ESS组中,诊断年龄>50岁和高级别是PFS的独立危险因素,高级别和淋巴管间隙侵犯是OS的独立危险因素。
结论:在中国子宫肉瘤患者中,绝经后和晚期与显著较差的预后相关.ESS的预后优于LMS。彩色多普勒血流显像阳性信号有助于识别LMS,未来需要在更大的样本中进一步测试。
BACKGROUND: Uterine sarcoma is a rare and heterogeneous gynecological malignancy characterized by aggressive progression and poor prognosis. The current study aimed to investigate the relationship between clinicopathological characteristics and the prognosis of uterine sarcoma in Chinese patients.
METHODS: In this single-center retrospective study, we reviewed the medical records of 75 patients with histologically verified uterine sarcoma treated at the First Affiliated Hospital of Xi\'an Jiaotong University between 2011 and 2020. Information on clinical characteristics, treatments, pathology and survival was collected. Progression-free survival (PFS) and overall survival (OS) were visualized in Kaplan-Meier curves. Prognostic factors were identified using the log-rank test for univariate analysis and Cox-proportional hazards regression models for multivariate analysis.
RESULTS: The histopathological types included 36 endometrial stromal sarcomas (ESS,48%), 33 leiomyosarcomas (LMS,44%) and 6 adenosarcomas (8%). The mean age at diagnosis was 50.2 ± 10.7 years. Stage I and low-grade accounted for the majority. There were 26 recurrences and 25 deaths at the last follow-up. The mean PFS and OS were 89.41 (95% CI: 76.07-102.75) and 94.03 (95% CI: 81.67-106.38) months, respectively. Univariate analysis showed that > 50 years, post-menopause, advanced stage, ≥ 1/2 myometrial invasion, lymphovascular space invasion and high grade were associated with shorter survival (P < 0.05). Color Doppler flow imaging positive signals were associated with shorter PFS in the LMS group (P = 0.046). The ESS group had longer PFS than that of the LMS group (99.56 vs. 76.05 months, P = 0.043). The multivariate analysis showed that post-menopause and advanced stage were independent risk factors of both PFS and OS in the total cohort and LMS group. In the ESS group, diagnosis age > 50 years and high-grade were independent risk factors of PFS, while high-grade and lymphovascular space invasion were independent risk factors of OS.
CONCLUSIONS: In Chinese patients with uterine sarcoma, post-menopause and advanced stage were associated with a significantly poorer prognosis. The prognosis of ESS was better than that of LMS. Color Doppler flow imaging positive signals of the tumor helped to identify LMS, which needs to be further tested in a larger sample in the future.