子宫内膜间质肉瘤术后辅助治疗方式探讨

Impact of adjuvant treatment modalities on the management of patients with endometrial stromal sarcoma

目的探讨辅助治疗对子宫内膜间质肉瘤(ESS)复发及生存的影响。方法回顾性分析自1983-2005年于北京协和医院治疗的37例ESS的病例资料,记录人口统计学信息、诊断及治疗信息,采用SPSS11.5软件Cox回归分析进行肿瘤复发相关因素多因素分析。结果 37例患者的中位年龄为42岁(18～61岁),初次手术时有24例(64.9%)患者切除了双侧附件,术后有24例(64.9%)接受了放疗、化疗、内分泌治疗或联合的辅助治疗。中位随诊时间78个月(12～393个月),17例(45.9%)患者在随访过程中肿瘤复发,中位复发时间为122.1个月,1例患者死亡。与肿瘤复发相关的多因素分析显示手术切除双侧卵巢可显著延缓复发(P=0.001),而患者年龄、绝经状况、FIGO分期及术后是否辅助治疗对肿瘤复发无显著性影响,但初次手术后给予内分泌治疗可显著延长患者的无瘤生存期(P=0.027)。结论 ESS是一种罕见的子宫恶性肿瘤,初次手术时行双附件切除并进行适当的辅助治疗特别是内分泌治疗可显著延缓复发。

Objective To evaluate the impact of adjuvant treatment on the survival of endometrial stromal sarcoma （ESS）. Methods Thirty-seven ESS patients were treated at Peking Union Medical College Hospital （PUMCH） between 1983 and 2005. The demographic, treatment and survival information were retrospectively reviewed. Data were analyzed using Cox proportional hazards regression. Results The median age of the patients was 42 years （ 18 -61 years）. 24 of 37 patients （64. 9% ） were given bilateral salpingo-oophorectomy （BSO） during the primary surgery and 24 patients received adjuvant hormonal therapy, radiation or chemotherapy after operation. With the median follow-up time 78 months （ 12 -393months）, 17 patients （45.9%） developed disease recurrence and the median disease free survival （DFS） was 122. l months, only one patient died of the disease. In the multivariate analysis, the major determinants of DFS were BSO （P =0. 001 ）. Patientg age, menstrual status, FIGO staging and adjuvant treatment had no significant impact on the DFS, while hormonal therapy after the primary surgery could prolong the DFS significantly （P = O. 027 ）. Conclusion ESS is a rare kind of uterine malignancy. BSO during the primary surgery, and appropriate adjuvant treatment especially hormonal therapy could prolong the DFS significantly.