低度恶性子宫内膜间质肉瘤41例临床分析  

Treatment and prognosis of low-grade malignant endometrial stromal sarcoma

作　　者：马绍康[1] 张宏图[2] 吴令英[1] 刘丽影[1] 李斌[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院妇瘤科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院病理科,北京100021

出　　处：《中华肿瘤杂志》2007年第1期74-78,共5页Chinese Journal of Oncology

摘　　要：目的分析低度恶性子宫内膜间质肉瘤（LESS）的治疗及预后情况，以期对这类肿瘤的治疗提供参考。方法回顾性分析41例LESS的治疗方法及其对肿瘤复发、患者存活的影响。采用寿命表法计算生存率。结果41例患者中，24例以不规则阴道出血为主要症状，30例术前诊断为子宫肌瘤。全部患者均行手术切除，33例术后接受了辅助治疗，包括放疗和（或）化疗。41例患者的5年和10年生存率分别为87．5％和77．8％。共有18例患者复发，复发率为43．9％，多数位于盆腔，中位复发时间为26个月，平均复发时间为31个月。保留卵巢功能患者的复发率（66．7％）高于不保留卵巢功能者（37．5％）；术后未接受辅助治疗患者的复发率为87．5％，而术后接受辅助治疗者复发率为30．3％，二者比较，差异有统计学意义（P〈0．05）。31例接受辅助放疗者中，10例（32．3％）复发，而未行放疗的10例患者中，有8例（80．0％）复发。18例复发患者的5年生存率为71．8％。结论LESS预后好，但复发率较高，而且有晚期复发的倾向。术后辅助放疗对减少局部复发有益。Objective To review the experience in the treatment of low-grade malignant endometrial stromal sarcoma. Methods The data of 41 patients with low-grade malignant endometrial stromal sarcoma surgically treated between 1982 and 2004 were reviewed. Statistical analysis was carded out using X^2 and Kaplan-Meier llfe table. Results Of these 41 patients, 24 suffered from irregular vaginal bleeding, and 30 had been diagnosed to have leiomyoma before treatment. Thirty patients but 11 underwent surgical management with uterus removed. Thirty-three patients received postoperative adjuvant therapy including radiation and/or chemotherapy. The 5-year and 10-year actuarial survival was 87.5% and 77.8%, respectively. Eighteen patients （43.9%） developed recurrent disease, most of which in the pelvis. The mean time to recurrence was 31 months （range 6 to 78 months） with the median time of 26 months. The recurrent rate was 66.7% for patients whose ovarian function was reserved versus 37.5% for those without reservation. Patients who received adjuvant therapy had a lower recurrent rate （30.3%） than those who did not （87.5%）. The recurrent rate of the patients treated with postoperative adjuvant radiation was 32.3% （10/31） versus 80% （8/10） for those patients without. The 5-year actuarial survival rate of patients with recurrent disease was 71.8%. Conclusion Low-grade malignant endometrial stromal sarcoma has a good prognoses though dwarfed by higher late recurrence after initial treatment. Postoperative adjuvant radiation is helpful to reduce local recurrence.

关 键 词：子宫内膜间质肉瘤 预后 

分 类 号：R686[医药卫生—骨科学]