摘要
目的评估子宫内膜间质肉瘤(ESS)的临床特点、治疗、结局和预后。方法 1983—2005年,共70例ESS患者就诊于北京协和医院,其中51例完成治疗及随诊。回顾性记录上述患者的人口学、临床病理学及生存信息,并采用Kaplan-Meier法和Cox回归分析进行单因素和多因素分析。结果 ESS为70例,占所有子宫肉瘤的44.3%(70/158)。平均年龄43.5岁。不正常阴道出血和子宫增大是最常见的症状和体征。26例(37.1%)患者术前通过诊断性刮宫明确诊断。在51例完成了治疗和随访的患者中,37例为低度恶性ESS(LGESS),14例为高度恶性ESS,后者目前命名为未分化子宫内膜间质肉瘤(UES)。所有患者中位生存期为334个月,5年生存率为87.8%。单因素分析显示,病理学类型为LGESS(P<0.0001)、手术时切除双侧卵巢(P<0.0001)及术后给予辅助治疗(P=0.0013)可延缓复发,病理学类型为LGESS可明显延长患者总生存期(P<0.0001);但多因素分析发现仅病理学类型(P<0.0001)和手术时行双卵巢切除(P=0.002)是影响DFS的独立因子。结论 ESS是一种罕见的子宫体恶性肿瘤,诊断性刮宫可提高术前诊断率。LGESS和UES有着完全不同的生物学行为,在治疗上也应区别对待;肿瘤的病理分类是独立的预后影响因子。
Objective To study the clinical features,treatment,outcome and prognosis of endometrial stromal sarcoma（ESS）.Methods 70 ESS patients were treated by Peking Union Medical College Hospital（PUMCH） from 1983 to 2005 and 51 of them went through the whole process of treatment and follow-up.Demographic,clinicopathologic and survival information were retrospectively reviewed.Univariate and multivariate analysis was performed by using Kaplan-Meier methods and Cox proportional hazards regression.Results ESS accounted for 44.3%（70/158）of all uterine sarcomas.The mean age of the patients was 43.5 years.Irregular vaginal bleeding and uterine enlargement were the most common symptoms and signs.26 cases（37.1%） were diagnosed preoperatively through diagnostic curettage.Among the 51 patients who had went through the whole process of treatment and follow-up,37 were diagnosed as low grade ESS（LGESS） with the other 14 diagnosed as high grade ESS,which is now classified as undifferentiated endometrial sarcoma（UES）.The median overall survival time was 334 months and the 5-year survival rate was 87.8%.Univariate analysis showed that disease free survival（DFS） was prolonged by classification of LGESS,bilateral salpingo-oophorectomy during the original surgery and adjuvant therapy（P0.0001,0.0001 and P=0.0013 respectively） with overall survival prolonged by LGESS classification significantly（P0.0001）.Multivariate analysis,on the other hand,showed that classification of LGESS and bilateral salpingo-oophorectomy during the original surgery were independent prognostic factors of DFS（P0.0001,and P=0.0013 respectively）.Conclusion ESS is a rare kind of uterine malignancy,and the preoperative diagnosis could be improved by diagnostic curettage.LGESS and UES represent two distinct clinical entities and should be treated differently.Pathological classification might be the most important independent prognostic factor.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第17期1957-1961,共5页
Chinese General Practice
关键词
肉瘤
子宫内膜间质
未分化子宫内膜肉瘤
诊断
治疗
Sarcoma
endometrial stromal
Undifferentiated endometrial sarcoma
Diagnosis
Therapy
