目的:子宫肉瘤是一种罕见的肿瘤,预后较差。他们的诊断通常是偶然的,手术后。我们的目标是研究子宫肉瘤的早期管理策略,评估指南依从性和专家中心转诊对子宫肉瘤患者治疗方法和临床结局的影响.
方法:我们回顾性分析了转诊至居里研究所并在法国NETSARC网络数据库中注册的子宫肉瘤患者的医疗记录。
结果:总计,100名患者,平均年龄为54岁,包括在分析中。MRI扫描(n=36),所有患者至少有两个提示恶性肿瘤的体征,和77.8%有四个或更多的迹象。65.6%的病例未进行术前活检。只有14.1%的患者在专家中心接受了初始手术。在网络外进行的手术与碎裂显着相关(32.9%vs.0%;p=0.036),更少的负利润率(R0利润率52.4%与100%;p=0.006),和对手术指南的依从性差(28.3vs.72.7%;p=0.013)。多变量分析显示,不坚持手术建议与无复发生存率无显著相关(HR=0.54;95%CI[0.21-1.38])。但却是总生存期较差的独立预测因子(HR=0.12;95%CI[0.03-0.52];p=0.005).
结论:尽管可疑的临床和放射学体征频率很高,大部分接受肉瘤手术的女性在专家网络之外接受治疗。我们提供指导方针,整合临床背景和放射学体征,以鼓励早期转诊到肉瘤参考中心。
OBJECTIVE: Uterine sarcomas are rare tumors with a poor prognosis. Their diagnosis is often incidental, following surgery. Our goal was to examine the early management strategies for uterine sarcomas, and to assess the impact of
guideline adherence and expert center referral on both the management approaches and the clinical outcomes in patients with uterine sarcomas.
METHODS: We retrospectively analyzed medical records from patients with uterine sarcoma referred to the Institut Curie and registered in the database of the French NETSARC network.
RESULTS: In total, 100 patients, with a median age of 54 years, were included in the analyses. On MRI scans (n = 36), all patients had at least two signs suggestive of malignancy, and 77.8 % had four or more signs. No preoperative biopsy was performed in 65.6 % of cases. Only 14.1 % of patients underwent initial surgery at an expert center. Surgery performed outside the network was significantly associated with morcellation (32.9 % vs. 0 %; p = 0.036), fewer negative margins (R0 margins 52.4 % vs. 100 %; p = 0.006), and poor adherence to surgical
guidelines (28.3 vs. 72.7 %; p = 0.013). Multivariate analysis showed that non-adherence to surgical recommendations was not significantly associated with relapse-free survival (HR = 0.54; 95 % CI [0.21-1.38]), but was an independent predictor of poor overall survival (HR = 0.12; 95 % CI [0.03-0.52]; p = 0.005).
CONCLUSIONS: Despite a high frequency of suspicious clinical and radiological signs, a large proportion of women undergoing sarcoma surgery are treated outside of expert networks. We provide
guidelines, integrating the clinical context and radiological signs to encourage early referral to reference centers for sarcoma.