子宫内膜间质肉瘤97例临床分析

Clinical review of 97 patients with endometriul stromal sarcoma

目的探讨子宫内膜间质肉瘤（ESS）患者的预后及其相关因素，并分析术后辅助治疗对其复发及生存的影响。方法回顾性分析1970年1月—2006年5月在中国医学科学院中国协和医科大学肿瘤医院收治的97例ESS患者的临床资料。其中，低度恶性子宫内膜间质肉瘤（LGESS）69例，高度恶性子宫内膜间质肉瘤（HGESS）16例，不详者12例。患者中位年龄44．0岁，中位随访时间62个月（5～277个月）；主要症状为阴道不规则流血（占43％）和经量增多、经期延长（占36％）。结果患者总的2年、5年累积生存率分别为93％和84％，LGESS与HGESS、Ⅰ～Ⅱ期与Ⅲ～Ⅳ期患者间的累积生存率比较，差异均有统计学意义（P〈0．05）；术后放疗与未放疗、化疗与未化疗患者间的累积生存率比较，差异均无统计学意义（P〉0．05）。97例ESS患者中共有34例（37％）患者出现复发转移，中位复发转移时间为27个月（3—150个月）。其中LGESS与HGESS复发转移率分别是25％和73％，两者比较，差异有统计学意义（P=0．007）；初次治疗保留卵巢功能和未保留卵巢功能者的复发转移率分别为89％和24％，两者比较，差异有统计学意义（P=0．000）；术后化疗与未化疗者的复发转移率分别为35％和37％，两者比较，差异无统计学意义（P〉0．05）。术后放疗与未放疗者的局部控制率分别为81％和43％，两者比较，差异有统计学意义（P=0．011）。结论HGESS的预后明显不如LGESS，初治时保留卵巢功能者复发转移的风险明显高于未保留卵巢功能者，术后放疗可提高ESS患者的局部控制率。

Objective To review the survival outcomes in patients with endometrial stromal sarcoma （ESS） in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, and to discuss prognostic factors and the role of post-operative adjuvant radiotherapy and chemotherapy. Methods Hospital records and pathology reports for 97 patients with ESS were reviewed. Among 97 patients, 69 had low-grade ESS （ LGESS）, 16 had high-grade ESS （HGESS） and 12 had unclear grade. The median age at diagnosis was 44. 0 years. The median follow-up time was 62 months （ 5 - 277 months）. Atypical vaginal bleeding （43%） and prolonged and increased menses （36%） were the main symptoms. Results Totally 2-year and 5-year cumulative survival rates were 93% and 84%, respectively. Cumulative survival curves were significantly different between LGESS and HGESS, and so did cumulative survival curves between stage Ⅰ - Ⅱ and stage Ⅲ- Ⅳ（P〈0.05）. Totally, 34 patients （37%） had local or distant recurrence. The median time-to-recurrence （TTR） was 27 months. The recurrence rates of the patients with or without preserve of ovary were 89% and 24% , respectively （ P =0. 000）. The local-control-rates of the patients who received or did not receive post-operative radiotherapy were 81% and 43%, respectively （P = 0. 011 ）. Conclusions The prognosis of HGESS is obviously worse than that of LGESS. The risk of recurrence of patients with preserve of ovary was remarkably higher than that of patients without preserve of ovary. Postoperative radiotherapy could increase the local-control-rates.