目的:探讨子宫肉瘤患者手术后的临床病理特征及预后。
方法:我们确定了所有在假定良性疾病的初次手术后偶然发现的子宫肉瘤患者,这些患者于2004年1月1日至2021年1月1日就诊于我们的机构并接受了完整手术的重新探查。我们分析了临床病理特征和预后。
结果:总体而言,我们的研究包括95名患者。对于最初的手术,50例进行了子宫肌瘤切除术(52.6%,50/95)患者,45例(47.4%,45/95)患者。对所有患者进行重新探索以完成分期手术。分期手术的中位时间为40天(范围为15-90天)。有29例患者(30.5%,29/95)有残余肉瘤,17例患者(17/95,17.9%)在剩余的子宫上,9例(9/95,9.5%)有播散性疾病,4例(4/95,4.2%)淋巴结阳性。约40例(42.1%)接受辅助化疗,55.2%(16/29)和36.4%(24/66)有/无残留疾病的患者接受了辅助化疗,分别为(P=0.087)。中位随访时间为76.7个月(IQR:34.8-118.1个月)。17例患者(17.9%)在再次探查手术后复发。整个队列的5年无进展生存率(PFS)和5年总生存率(OS)分别为81.7%和92.1%,分别。残余肉瘤患者的5年PFS和5年OS倾向较差,与没有(5年PFS:75.6%vs.84.5%,P=0.224;5年OS:85.5%95.1%,P=0.217)。播散性疾病患者的5年OS较差(62.5%vs.95.1%,P=0.007)和非显著较差的5年PFS(64.8%vs.83.4%,P=0.153)与没有。
结论:经手术治疗的子宫肉瘤患者有良好的生存率。与没有传播疾病的患者相比,有传播疾病的患者的5年OS更差。手术再探查对于去除残余肉瘤和播散性疾病可能是有价值的。
OBJECTIVE: To investigate the clinicopathological characteristics and prognosis of patients with uterine sarcoma treated following surgery for presumed benign disease.
METHODS: We identified all patients with uterine sarcoma found incidentally after primary surgery for presumed benign disease who presented to our institution and received re-exploration for completion surgery from January 1, 2004 to January 1, 2021. We analyzed the clinicopathological characteristics and prognosis.
RESULTS: Overall, 95 patients were included in our study. For the initial surgery, myomectomy was performed in 50 (52.6%, 50/95) patients, hysterectomy was performed in 45 (47.4%, 45/95) patients. All patients were re-explored to complete the staging operation. The median time to the staging surgery was 40 days (range 15-90 days). There were 29 patients (30.5%, 29/95) had remnant sarcomas, with 17 patients (17/95, 17.9%) on the remaining uterus, 9 patients (9/95, 9.5%) had disseminated diseases, and 4 patients (4/95, 4.2%) had positive lymph nodes. About 40 patients (42.1%) received adjuvant chemotherapy, 55.2% (16/29) and 36.4% (24/66) patients with/without remnant diseases received adjuvant chemotherapy, respectively (P = 0.087). The median follow-up duration was 76.7 months (IQR: 34.8-118.1 months). And 17 patients (17.9%) had recurrence following re-exploration surgery. 5-year progression-free survival (PFS) and 5-year overall survival (OS) for the entire cohort was 81.7% and 92.1%, respectively. Patients with remnant sarcomas had a tendency towards a worse 5-year PFS and 5-year OS, compared with those without (5-year PFS: 75.6% vs. 84.5%, P = 0.224; 5-year OS: 85.5% vs. 95.1%, P = 0.217). Patients with disseminated diseases had a worse 5-year OS (62.5% vs. 95.1%, P = 0.007) and non-significantly worse 5-year PFS (64.8% vs. 83.4%, P = 0.153) compared with those without.
CONCLUSIONS: Patients with uterine sarcoma treated following surgery for presumed benign disease have a favorable survival. Patients with disseminated diseases had a worse 5-year OS compared with those without. Surgical re-exploration may be valuable for removing remnant sarcomas and disseminated diseases.