Ⅰ期PR阳性低级别子宫内膜间质肉瘤患者术后激素治疗的预后及相关因素分析

Clinical outcomes of postoperative hormonal treatment in patients with low-grade endometrial stromal sarcoma at stageⅠand its related factors

背景低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma,LGESS)是一种罕见的妇科恶性肿瘤。对于Ⅰ期LGESS患者,术后激素治疗对预后的影响尚无定论。目前临床经验治疗是对病理免疫组化为孕激素受体(progesterone receptor,PR)阳性的患者给予激素治疗。目的探讨术后激素治疗对Ⅰ期且PR阳性的LGESS患者的作用及相关因素对预后的影响。方法回顾性分析解放军总医院第一医学中心1992年6月-2021年10月共33例Ⅰ期LGESS患者的临床资料,所有患者均经病理确诊,且病理免疫组化为PR阳性。根据是否给予激素治疗(高效孕激素或雌孕激素联合治疗)进行分组,以探讨激素治疗及相关因素对其预后的影响。结果33例PR阳性的Ⅰ期LGESS患者中,共13例在术后接受了激素治疗,20例未接受激素治疗。两组间除是否行放疗(P=0.026)外,在年龄、婚姻状态、绝经状态、子宫保留、卵巢保留、淋巴结清扫及化疗方面均衡可比。激素治疗组与对照组的无进展生存期、总生存期、平均无进展生存期(78.15个月vs 63.65个月)和平均总生存期(103.08个月vs 79.85个月)差异均无统计学意义(P均>0.05)。33例中,保留卵巢11例,放疗10例,保留卵巢组与未保留卵巢组无进展生存期(P=0.267)和总生存期(P=0.717)差异均无统计学意义;放疗组与未放疗组无进展生存期(P=0.186)和总生存期(P=0.580)差异均无统计学意义。结论Ⅰ期且PR阳性的LGESS术后患者,激素治疗组患者平均无进展生存期和总生存期均较对照组延长,但其组间差异无统计学意义,激素类药物的使用应慎重。此结果仍须更大样本量的进一步研究。

Background Low-grade endometrial stromal sarcoma(LGESS)is a rare gynecological malignancy.For LGESS patients at stageⅠ,the value of postoperative adjuvant treatment on its prognosis is inconclusive.At present,its clinical treatment is to administer hormone therapy to patients with pathological immunohistochemistry positive for progesterone receptor(PR).Objective To investigate the effect of postoperative hormonal treatment in LGESS patients at stageⅠwith PR positive,and analyze the influencing factors on the prognosis.Methods A retrospective comparative clinical study was conducted in 33 PR–positive and LGESS patients at stageⅠwho were treated in our hospital from June 1992 to October 2021.All patients were confirmed by pathology,and their pathological immunohistochemistry showed positive PR.According to whether hormone therapy(synthetic progesterone or estrogen progesterone combination therapy)was given,the patients were divided into treatment group and observation group,the impact of hormone therapy and related factors on its prognosis were analyzed.Results Of the 33 cases,13 patients were included in the hormonal treatment group and 20 patients in the observation group.With the exception of postoperative radiation(P=0.026),there were matched in age,marital and menopausal status,surgical scope,and postoperative chemotherapy.The differences were not statistically significant in PFS,OS,mean PFS(78.15 months vs 63.65 months)and mean OS(103.08 months vs 79.85 months)between the hormonal treatment group and the observation group(all P>0.05).Of the 33 cases,11 patients had a hysterectomy with ovarian conservation,and 10 cases underwent radiotherapy.The differences in PFS and OS between the ovarian preservation group and the bilateral salpingo oophorectomy group,and in PFS and OS between radiotherapy group and without radiotherapy group were not statistically significant(all P>0.05).Conclusion Hormonal treatment should be carefully selected for postoperative low-grade endometrial stromal sarcoma patients at stageⅠwith PR positive expression,although the mean PFS andOS in hormonal treatment group are prolonged compared with the control group,the differences between the two groups are notstatistically significant.The result should be further studied with a larger sample size.