子宫癌肉瘤26例临床病理及预后影响因素分析

Clinical pathology and prognostic factors of carcinosarcomas of uterus:an analysis of 26 cases

目的探讨子宫癌肉瘤的临床病理特征及预后影响因素。方法收集1997年1月～2004年12月在复旦大学附属妇产科医院诊治的26例子宫癌肉瘤患者的临床病理资料,进行预后影响因素分析。结果26例患者平均年龄59.5岁,20例(76.9%)患者已绝经,主要症状是异常阴道流血。手术时,21例(80.8%)患者未发现残留病灶,其中10例(47.6%)术后出现复发,平均缓解期为15个月,平均生存时间18个月。26例患者均获得随访,总5年生存率26.5%,中位生存时间(33±7.33)个月,其中临床分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为79.1%、37.5%、13.3%、0,且Ⅰ+Ⅱ期的5年生存率明显高于Ⅲ+Ⅳ期(P=0.006)。单因素分析显示:肿瘤大小、肌层浸润深度、有无淋巴结转移、有无残留病灶以及临床病理分期均与预后相关。多因素分析显示:临床病理分期是独立的预后影响因素(P=0.035)。结论子宫癌肉瘤是侵袭性肿瘤,易发生子宫外播散、转移。临床病理分期是独立的预后影响因素,提高早期检出率,改进治疗措施对提高子宫癌肉瘤的生存率有重要意义。

Purpose To review the clinicopathological features and to identify prognostic factors in uterine carcinosarcomas. Methods Twenty-six cases of of the uterus were studied retrospectively at Fudan University affiliated Obstetric and Gynecologic Hospital from January 1997 to December 2004. Results Twenty-six patients with median age of 59. 5 years were analyzed, in which twenty （76. 9% ） were menopausal. Abnormal vaginal bleeding was the most common symptom. There were nine patients with stage Ⅰ, five with stage Ⅱ , ten with stage Ⅲ and two with stage Ⅳ disease. There was a significantly difference of survival distribution between the low-stage group （ stages Ⅰ and ） and the high-stage group （ stages Ⅲ and Ⅳ ） （ P = 0. 006）. At the completion of primary surgery, 21 （80. 8% ） patients had no macroscopic residual tumors, Ten （47. 6% ） of these patients had recurrence of disease, the median disease-free time was 15 months, and median overall survival was 18 months. All patients were followed up with median overall survival of 33 months, a 5-year survival rate of 26. 5% for all stages. Univariate analysis showed that clinicopathological variables including tumor size, depth of myometrial invasion, residual disease, positive lymph node, surgical stage have a significant association with overall survival. Multivariate analysis using the Cox proportional hazards model showed that only surgical stage remained a significant independent predictive variable （ P = 0. 035 ）. Conclusions Uterine carcinosarcoma is a rare aggressive tumor with a high tendency to spread and high relapse rate resulting in extremely poor overall survival. In this study, although the number of cases is small, the surgical stage is an independent factor in prediction of survival in uterine carcinosarcoma. Survival rate remains to be improved.