子宫颈肉瘤21例临床分析

Cervical Sarcomas: An Analysis of 21 Cases

目的分析子宫颈肉瘤患者的临床特点及不同治疗方式、不同病理类型患者的生存情况。方法回顾性分析21例肉瘤患者的临床资料。结果21例患者中癌肉瘤（恶性中胚叶混合瘤）9例，胚胎性横纹肌肉瘤（葡萄状肉瘤）6例，平滑肌肉瘤5例，内膜间质肉瘤1例。21例患者的中位年龄43岁，其中癌肉瘤患者的中位年龄47岁（19～69岁），平滑肌肉瘤患者的中位年龄43岁（34～47岁），胚胎性横纹肌肉瘤患者的中位年龄21岁（20～37岁）。21例患者均有阴道出血症状及宫颈肿瘤。6例胚胎性横纹肌肉瘤的患者均有质脆的葡萄状肿物填满整个阴道并有肿块脱出。4例患者仅行单纯放疗，17例患者均采用联合治疗。本组有6例患者肿瘤复发，复发率为28．5％（6／21）。中位复发时间为29个月（10～194个月）。6例患者在1年内死亡，2例生存已超过10年。寿命表法计算21例患者的生存概率为：1年70.0％，3年36．9％，5年22．1％。4例单纯放疗患者分别于治疗后3．6、32、36个月死亡；2例放疗加化疗的患者分别于治疗后4、10个月死亡；15例手术联合放疗和／或化疗的患者，4例分别于治疗后2、4、5、24个月死亡，儿例患者随访中，其中8例生存已超过2年，5例已超过3年，3例已超过5年，其中2例长期生存已超过10年。5例平滑肌肉瘤患者，1例治疗后6个月死亡，4例生存已超过32个月，最长1例已生存了318个月；6例胚胎性横纹肌肉瘤患者，2例于治疗后2、4个月死亡，3例生存超过28个月，2例已超过5年，最长生存156个且无肿瘤复发；9例癌肉瘤患者，6例分别于治疗后3、4、5、24、32、36个月死亡，1例生存超过48个月，另2例分别在治疗后18、37个月失访；1例内膜间质肉瘤治疗后6个月死亡。结论子宫颈肉瘤以手术联合化疗和或放疗为宜，胚胎性横纹肌肉瘤、平滑肌肉瘤患者的预后较好，而癌肉瘤患者的预后差。

Objective To evaluate the clinical characteristics of cervical sarcomas and the survival of different treatment methods and pathological types. Methods 21 patients with cervical sarcomas treated at the Cancer Hospital, PUMC, CAMS were retrospectively analyzed. Results 9 of the tumors were carcinosarcomas, 6 patients were embryonal rhabdomyosarcomas, 5 were leiomyosarcomas, and one was endometrial stromal sarcoma. The median age of all patients was 43 years, of witch 47 years with carcinosarcomas, 43 years with leiomyosarcomas, and 21 years with embryonal rhabdomyosarcomas. All patients presented with vaginal bleeding and cervical tumors. Six patients with embryonal rhabdomyosarcomas had passed grape-like tissues per vaina. All patients received combined treatment, Except 4 patients receiving radiotherapy alone. 6/21 （28.5 %） patients had recurrence. The median time to recurrence was 29 months （range 10-194）. 6/21 patients died with disease within one year, but 2 patients survived more than 10 years. The 1-year, 3-year and 5-year survival rate were 70.0%, 36.9% and 22.1%. Four patients treated by radiotherapy alone died with disease 3, 6, 32 and 36 months after treatment respectively. Two patients treated with radiotherapy and chemotherapy died after 4 and 10 months. Of 15 patients receiving surgery combined with chemotherapy and or radiotherapy, 4 patients died at 2, 4, 5 and 24 months, 8 patients have lived more than 2 years, 5 patients more than 3 years and 3 patients more than 5 years. 5 patients with leiomyosarcomas survived more than 32 months, except one patient died after 6 months. The longest one survived 318 months. Of 6 patients with embryonal rhabdomyosarcomas, two patients died with disease 2 and 4 months after treatment. 3 patients survived more than 28 months, 2 patients survived more than 5 years, and the longest one has already lived 156 months without disease. Of 9 with carcinosarcomas, six patients died with disease 3, 4, 5, 24, 32 and 36 months after treatment. One patient with endometrial stromal sarcoma died after 6 months. Conclusion Patients with cervical sarcomas should treated with surgery combined with chemotherapy and or radiotherapy. Patients with embryonal rhabdomyosarcomas and patients with leiomyosarcomas have a better prognosis than patients with carcinosarcomas.