女性生殖道癌肉瘤37例临床及预后分析

Clinical and prognosis analysis of 37 cases of carcinosarcomas in female reproductive tract

目的对37例女性生殖道癌肉瘤的诊断、治疗及预后进行分析。方法对1996年-2006年复旦大学附属妇产科医院住院手术治疗的37例女性生殖道癌肉瘤的临床、病理和预后资料进行回顾性分析。结果37例癌肉瘤中Ⅰ期15例、Ⅱ期9例、Ⅲ期11例、Ⅳ期2例。Ⅰ-Ⅱ期、Ⅲ-Ⅳ期的3年总生存率分别为84.6%、33.3%,差异有统计学意义(P=0.007)。对恶性腺体和间叶组织来源、淋巴结转移、肌层浸润深度(仅对子宫癌肉瘤)、脉管浸润、p53基因表达、年龄(分<60岁和≥60岁2组)、妊娠次数(分≤4次和>4次2组)、是否化疗放疗与预后的关系进行统计学分析。单因素分析表明,肌层浸润深度(P=0.006)、脉管浸润(P=0.046)、年龄(P=0.027)、妊娠次数(P=0.047)与预后有关;多因素分析表明,对于子宫癌肉瘤,年龄(P=0.033)和肌层浸润深度(P=0.027)与预后有关。对于所有癌肉瘤,淋巴结转移(P=0.022)和p53基因表达(P=0.032)与预后有关。结论女性生殖道癌肉瘤患者的预后可能与年龄、肌层浸润深度、淋巴结转移、脉管浸润、妊娠次数及p53基因表达等有关。加强对绝经后妇女的妇科超声普查对早发现生殖道癌肉瘤有一定的意义。

Objective To investigate the diagnosis,treatment and prognosis of carcinosarcomas（CS）in female reproductive tract.Methods Thirty-seven cases of CS treated in our hospital between 1996-2006 were reviewed.The clinico-pathologic characteristics,treatment and prognosis were retrospectively analyzed.Results The overall survival for patients with stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ was 84.6% and 33.3%（P=0.007）,respectively.Patients＇myometrial invasion,vessel invasion,age and times of pregnancy were associated with prognosis by univariate analysis（P〈0.05）,while in a multivariate analysis age and myometrial invasion were associated with prognosis（P〈0.05）in the uterine CS and lymph node metastasis and the expression of p53 were associated with prognosis（P〈0.05）in all CS.Conclusions The prognosis of CS were associated with age,myometrial invasion,lymph node metastasis,vessel invasion,times of pregnancy and the expression of p53.It＇s useful for the early diagnosis of CS by ultrasonography for the menopausal women.