| Objective: Uterine sarcoma features for rarity,aggressive clinical behaviour andpoor prognosis.The lack of sensitive auxiliary examination and special tumor markershas contributed a lot of difficulty to standardized diagnosis and optimal treatment forthe complicated histopathological diversity.2012NCCN clinical practice guidelinesabout uterine cancer suggests that stage I uterine sarcoma should accept surgerytherapy.However,there are no more detail suggestions about synchronouslymphadenectomy and postoperative adjuvant chemotherapy and radiation because ofthe lack of enough clinical evidence.We are aimed to elevate diagnosis rate and survivalrate of early stage uterine sarcoma by evaluating the clinical features,treatment outcomeand prognosis of stage I uterine sarcoma.Methods: A retrospective analysis was performed on47patients withhistologically verified stage I uterine sarcoma who were treated and followed at Dalianmaternity hospital from October2002to October2011. Histologically,2003WorldHealth Organization (WHO) classification was used in our study.The2009InternationalFederation of Gynecology and Obstetrics (FIGO) criteria had been used to assign stagesfor uterine sarcoma.Use SPSS15.0software for data processing system.There wereseven factors including age,menopause status,histopathological type,FIGO stage,lymphadenectomy,postoperative adjuvant therapy and lymph-vascular space invasion instatistical analysis.For univariate analysis,Kaplan-Meier curves were generated, andLog-rank tests were used to evaluate survival differences.Multivariate analysis wasperformed by Cox proportional hazards regression model.The test level was0.05.Results: Histological analysis revealed that18(38.3%) patients hadleiomyosarcoma,15(31.9%) patients had low grade endometrial stromal sarcoma,7(14.9%) patients had adenosarcoma and7(14.9%) patients had malignant mixedmullerian tumors.Surgical stages,as defined by2009the International Federation of Gynecology and Obstetrics(FIGO) system,were Ia in28(59.6%) patients,Ib in19(40.4%)patients.Of the47stge I uterine sarcoma,there were26patients older than50and theother21patients were younger than50,including23premenopause patients and24postmenopause patients.All patients underwent surgical treatment and22(46.8%)casesreceived adjuvant therapy.28(59.6%) cases were diagnosed certainty by pathologythrough diagnostic curettage preoperatively or through frozen examinationintraoperatively.What’s more,the pathology report of2cases showed positivelymph-vascular space invasion and the type of Histological was endometrial stromalsarcoma and carcinosarcoma.20(42.6%)cases were performed total hysterectomy andbilateral salpingo-oophorectomy with pelvic/para-aortic lymphadenectomy.The5-yeardisease-free survival rate was70%and the5-year overall survival rate was62%.Univariate analysis showed that disease free survival was prolonged by age below50years,premenopause,classification of low grade endometrial stromal sarcoma andadjuvant therapy (P=0.014,0.022,0.045andP=0.020respectively) with overall survivalprolonged by premenopause,adjuvant therapy and FIGO stage(P=0.033,0.002andP=0.026respectively).Multivariate analysis revealed that age(P=0.023,RR=5.853) and FIGO stage(P=0.047,RR=3.245) were independent prognosis factors ofdisease free survival,while FIGO stage(P=0.035, RR=6.104),Histological type(P=0.020),lymph-vascular space invasion(P=0.024,RR=31.939) and adjuvant therapy(P=0.002,RR=0.034) were independent prognosis factors of overall survival.Conclusions:1.We should focus on patients with high risks because of commonclinical presentation of stage I uterine sarcoma.A second surgery might be omitted bydiagnostic curettage preoperatively joined by frozen examination intraoperatively whichwas beneficial for radical therapy.2.Age and FIGO stage were independent prognosisfactors of disease free survival,while FIGO stage,Histological type,lymph-vascularspace invasion and adjuvant therapy were independent prognosis factors of overallsurvival. |
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