子宫肉瘤预后的多因素分析

Multivariate analysis of prognostic factors for uterine sarcoma

目的 了解影响子宫肉瘤预后的有关因素。方法 对 134例患者的临床资料进行回顾性分析。结果 134例患者总的2年、5年生存率分别为 5 4 .4 4 %和 4 3.6 0 % ,复发率为 5 8.96 % (79/ 134)。单因素分析显示 :(1)年龄 <5 0岁者预后好于年龄≥5 0岁者 (P =0 .0 0 0 1)。 (2 )患者的绝经状态与预后有关 ,未绝经者生存率高于已绝经者 (P =0 .0 0 0 1)。 (3)生存率与手术病理分期有关 ,Ⅰ、Ⅱ期患者的生存率高于Ⅲ ,Ⅳ期患者 (P =0 .0 0 5 6 )。 (4)生存率与病理类型有关 ,MMMT患者的生存率低于LMS和ESS (P =0 .0 0 11)。 (5 )扩大手术范围并不能改善患者的生存率 (P >0 .0 5 )。 (6 )手术后辅助动脉灌注化疗能改善患者的预后 (P =0 .0 0 8)。多因素分析显示 :仅绝经状态、手术分期和辅助化疗三个因素与患者的预后有关 ,其中手术分期是影响患者预后的最重要因素 (P =0 .0 0 0 4 )。结论 绝经状态、手术分期和术后辅助化疗是影响患者生存率的三个独立因素。辅助化疗(经盆腔动脉灌注化疗药物 )不仅能减少复发 ,而且能改善患者的生存率。

Objectives To identify the clinical, pathological, or therapeutical factors which could influence the prognosis of uterine sarcoma patients. Methods 134 cases of uterine sarcoma (US) were retrospectively reviewed. Results The overall 2 and 5 year survival rates were 54.44% and 43.60% respectively. 79 out of 134 patients (58.96%) relapsed. Univariate analysis showed that: (1) Patients whose age over 50 had a better survival than those under 50( P =0.0001).(2) Menopause was correlated significantly to the survival ( P =0.0001).Premenopausal patients had a better survival than those postmenopausal cases. (3) Survival depended on surgical stage. The survival rates of stageⅠ and Ⅱ were higher than those stage Ⅲ and Ⅳ( P =0.0056). (4)Survival depended on the histopathology of the tumor. The survival for mullerian mixed mesodermal sarcoma was worse than that for leiomyosarcoma and endometrial sarcoma ( P =0.0011). (5) Extended surgery had no significance to survival ( P >0.05).(6)Interventional radiology adjuvant chemotherapy (IRAC) after surgery improved the prognosis( P =0.0015).The prognostic factors based on multivariate analysis were menopause status ,surgical stage, and IRAC. Surgical stage was the most significant prognostic factor ( P =0.0004). Conclusion The prognosis of US is significantly related with menopause status, surgical stage and adjuvant chemotherapy. IRAC can reduce the recurrence rate and improve the survival rate.