子宫恶性潜能未定的平滑肌瘤72例临床病理分析  

Clinical and pathological analysis of 72 cases of uterine smooth muscle tumor of uncertain malignant potential

作　　者：王湘炼 施秀[2] 王聪 王玉红 余文念 朱姝 丁琰 周金华[2] 王秀丽 Wang Xianglian;Shi Xiu;Wang Cong;Wang Yuhong;Yu Wennian;Zhu Shu;Ding Yan;Zhou Jinhua;Wang Xiuli(Department of Obstetrics and Gynecology,the First Clinical School of Medicine,Nanjing Medical University,Nanjing210029,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Soochow University,Suzhou215006,China;Department of Pathology,Jiangsu Province Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing210036,China;Department of Pathology,the First Affiliated Hospital of Soochow University,Suzhou215006,China;Department of Gynecology,Jiangsu Province Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing210036,China)

机构地区：[1]南京医科大学第一临床医学院妇产科学系,南京210029 [2]苏州大学附属第一医院妇产科,苏州215006 [3]南京医科大学第一附属医院江苏省人民医院病理科,南京210036 [4]苏州大学附属第一医院病理科,苏州215006 [5]南京医科大学第一附属医院江苏省人民医院妇科,南京210036

出　　处：《中华妇产科杂志》2024年第12期933-943,共11页Chinese Journal of Obstetrics and Gynecology

基　　金：江苏省卫生健康委员会重点课题(K2023054)。

摘　　要：目的对比分析子宫恶性潜能未定的平滑肌瘤(STUMP)与普通子宫平滑肌瘤(UL)和富于细胞性子宫平滑肌瘤(CUL)临床病理特征的差异,并寻找预测STUMP复发的指标。方法收集2015年6月—2024年3月南京医科大学第一附属医院和苏州大学附属第一医院收治的72例STUMP患者(STUMP组)的临床病理资料及随访资料,以同期南京医科大学第一附属医院收治的UL、CUL各72例患者(分别为UL组、CUL组)作为对照,比较3组患者间临床病理特征的差异,分析3组患者的复发情况并探讨影响STUMP复发的相关因素。结果(1)3组患者临床病理特征的比较:STUMP、UL、CUL组3组患者的年龄、子宫肌瘤剔除术史的比例、术前血清乳酸脱氢酶(LDH)水平分别比较,差异均有统计学意义(P均<0.05);其中,STUMP组患者的年龄显著高于UL组(P<0.05),STUMP组患者子宫肌瘤剔除术史的比例、术前血清LDH水平均显著高于UL组和CUL组(P均<0.05)。STUMP、UL、CUL组患者超声检查提示肌瘤边界不清的比例分别为22%(16/72)、3%(2/72)、11%(8/72),3组间比较,差异有统计学意义(χ2=12.94,P=0.002);其中,STUMP组显著高于UL组(P<0.05)。3组患者的免疫组化特征包括p16阳性、p53突变型、细胞增殖相关核抗原(Ki-67)指数>10%的比例分别比较,差异均有统计学意义(P均<0.05);其中,STUMP组患者的p16阳性、p53突变型、Ki-67>10%的比例均显著高于UL组(P均<0.05)。STUMP、UL、CUL组患者初次手术时行子宫切除术的比例分别为72%(52/72)、38%(27/72)、53%(38/72),3组间比较,差异有统计学意义(χ2=17.89,P=0.001);分别与UL、CUL组相比,STUMP组接受肌瘤剔除术的比例均显著降低(P均<0.05)。STUMP组20例行子宫肌瘤剔除术的患者中,6例术后病理诊断为STUMP后补充行子宫全切除术。(2)3组患者的复发情况:STUMP、UL、CUL组患者术后的中位随访时间分别为38、12和29个月,随访期内分别有3例(6%,3/53)、4例(7%,4/55)、8例(13%,8/62)复发,3Objective To compare and analyze the differences in clinical and pathological features of uterine smooth muscle tumor of uncertain malignant potential(STUMP),common uterine leiomyoma(UL),and cellular uterine leiomyoma(CUL),and to identify biomarkers for predicting STUMP recurrence.Methods A total of 72 cases of STUMP patients(STUMP group)treated at the First Affiliated Hospital of Nanjing Medical University and the First Affiliated Hospital of Soochow University were collected from June 2015 to March 2024.Additionally,72 cases of UL and 72 cases of CUL(UL group and CUL group)in the same period were collected as controls.The clinical and pathological features of the three groups were compared,and the recurrence rates and related factors affecting STUMP recurrence were analyzed.Results (1)Comparison of clinical and pathological features:there were statistically significant differences in age,history of myomectomy,and preoperative serum lactate dehydrogenase(LDH)levels among STUMP,UL,and CUL groups(all P<0.05).STUMP group were significantly older than UL group(P<0.05).The proportions of STUMP group with a history of myomectomy and elevated preoperative serum LDH levels were significantly higher than those in UL and CUL groups(all P<0.05).On ultrasound,16 cases of STUMP patients(22%,16/72),2 cases of UL patients(3%,2/72),and 8 cases of CUL patients(11%,18/72)had unclear fibroid borders,with significant differences between the three groups(χ²=12.94,P=0.002),with STUMP group significantly higher than UL group(P<0.05).Regarding immunohistochemistry,the proportion of p16 positivity,p53 mutations,and nuclear antigen associated with cell proliferation(Ki-67)>10%were significantly higher in STUMP group compared to UL group(P<0.05).In terms of surgical approach,52 cases of STUMP patients(72%,52/72)underwent hysterectomy,compared to 27 cases of UL patients(38%,27/72)and 38 cases of CUL patients(53%,38/72),with a significant difference between the three groups(χ²=17.89,P=0.001).The proportion of patients who underwent myom

关 键 词：子宫肿瘤 平滑肌瘤 恶性潜能未定的平滑肌肿瘤 延胡索酸水合酶 

分 类 号：R737.33[医药卫生—肿瘤]