无肌侵犯的子宫内膜癌肉瘤。

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Giuseppe Cucinella, William A Zammarrelli, Dimitrios Nasioudis, Sofia Gabrilovich, Ilaria Capasso, Roberto Berretta, Paolo Scollo, Francesco Raspagliesi, Glauco Baiocchi, Giuseppe Barresi, Basilio Pecorino, Giorgio Bogani, Katherine C Kurnit, Louise De Brot, Antonio Lembo, Shahi Maryam, Angela J Fought, Michaela E McGree, Vito Chiantera, Jesus Gonzalez Bosquet, Francesco Fanfani, Giovanni Scambia, Nadeem R Abu-Rustum, Andrea Mariani, Robert Giuntoli, Gretchen Glaser, Mario M Leitao
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引用次数: 0

摘要

目的:不侵犯肌瘤,局限于子宫内膜/息肉或子宫切除术时无残留子宫病变的子宫癌肉瘤极为罕见,肿瘤预后未知。因此,本研究旨在评估无肌侵犯的癌肉瘤患者的长期预后。方法:选取1998年12月至2023年1月在全球11个中心接受手术治疗的2009年国际妇产科联合会(International Federation of Gynecology and Obstetrics) IA期无肌侵犯癌肉瘤患者。根据肿瘤状态(限于子宫内膜,限于息肉,子宫切除标本中无残留疾病)和辅助治疗类型(化疗与不化疗)对患者进行分类。生存分析随访限于手术后的前5年。结果:97例患者中,28例(28.9%)病变局限于息肉,55例(56.7%)病变局限于子宫内膜,14例(14.4%)在子宫切除标本中无残留病变。患者接受单纯观察(n=16, 16.5%)、单纯阴道近距离放疗(n=14, 14.4%)、外放射线治疗±阴道近距离放疗(n=5, 5.2%)、化疗±阴道近距离放疗(n=51, 52.6%)、化疗+外放射线治疗±阴道近距离放疗(n=7, 7.2%),辅助治疗不详4例(4.1%)。29例患者(29.9%)复发,多数为远期复发。5年无复发生存率为63.5% (95% CI 53.4% ~ 75.4%),总生存率为72.0% (95% CI 62.6% ~ 82.9%)。无复发患者的中位随访时间为56.9个月(四分位数范围;21.8 - -72.9)。基于肿瘤状态的无复发生存期和总生存期无显著差异(p=。99和p=。分别为43)。在接受化疗的基础上,无复发生存期和总生存期差异无统计学意义(p=。08和p=。07年,分别)。结论:无肌侵犯性癌肉瘤患者预后差,复发率高,呈远处型。化疗的使用没有达到统计学意义,但可能受到我们小系列研究的限制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endometrial carcinosarcoma without myoinvasion.

Objective: Uterine carcinosarcoma without myoinvasion, limited to the endometrial lining/polyp or with no residual uterine disease at the time of hysterectomy, is extremely uncommon, with unknown oncologic outcomes. Thus, this study aimed to evaluate the long-term outcomes of patients with carcinosarcoma without myoinvasion.

Methods: Patients with International Federation of Gynecology and Obstetrics 2009 stage IA carcinosarcoma without myoinvasion who underwent surgery from December 1998 to January 2023 were identified from 11 centers worldwide. Patients were classified by tumor status (limited to the endometrium, limited to polyp, no residual disease in the hysterectomy specimen) and by type of adjuvant therapy (chemotherapy vs no chemotherapy). Survival analysis follow-up was limited to the first 5 years after surgery.

Results: Of 97 patients included, 28 (28.9%) had disease confined to a polyp, 55 (56.7%) to the endometrium, and 14 (14.4%) had no residual disease in the hysterectomy specimen. Patients received observation only (n=16, 16.5%), vaginal brachytherapy alone (n=14, 14.4%), external beam radiation therapy ± vaginal brachytherapy (n=5, 5.2%), chemotherapy ± vaginal brachytherapy (n=51, 52.6%), and chemotherapy and external beam radiation therapy ± vaginal brachytherapy (n=7, 7.2%), whereas adjuvant therapy was unknown in 4 patients (4.1%). A total of 29 patients (29.9%) recurred, mostly with a distant pattern of relapse. The 5-year recurrence-free survival was 63.5% (95% CI 53.4% to 75.4%) and the overall survival was 72.0% (95% CI 62.6% to 82.9%). The median follow-up for patients without recurrence was 56.9 months (interquartile range; 21.8-72.9). No significant differences were observed in recurrence-free survival and overall survival based on status of the tumor (p=.99 and p=.43, respectively). The difference in recurrence-free survival and overall survival was not statistically significant based on the receipt of chemotherapy (p=.08 and p=.07, respectively).

Conclusions: Patients with carcinosarcoma without myoinvasion have a poor prognosis, with a high recurrence rate with distant pattern. The use of chemotherapy did not achieve statistical significance but may be limited by our small series.

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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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