| Objective:To analyze the clinical features, features of ultrasound, therapy and factors affecting the prognosis of uterine sarcomas with different histological types, and to provide clinical datas for the diagnosis, treatments and prognosis of uterine sarcoma.Methods:Retrospectively analyze the datas of case history, including clinical features, therapy and status right now, of162cases of uterine sarcoma patients treated at Qilu Hospital of Shandong University between1/1999and12/2013. SPSS20.0was used for statistical analysis of clinical datas of uterine sarcoma patients. The enumeration datas of the clinical features and ultrasound features were compared by χ2test, and the measurement datas were compared by t test. The analysis of survival curve was used for the survival rate of the uterine sarcomas. The single factors were analyzed using logistic regression and Kaplan-Meier, and multi-factor analysis were analyzed using the Cox proportional hazards model analysis. P<0.05was the standard of statistical significance in each analytical test method.Results:1. Clinical features1.1AgeThese162uterine sarcomas’mean age was48.41±0.977, the median age was47.5years. Difference was significant among the mean age of different histological types(P<0.001). The patients with CS were oldest than others, whose median age was 1.2MenstruationAmong these162uterine sarcomas,63patients were post-menopause and99were pre-menopause, the difference between both groups was statistically significant(P<0.001). There are70.6%CS patients with post-menopause.1.3Clinical manifestationsThe most common first symptom of uterine sarcoma patients is abnormal vaginal bleeding, whose rate was52.5%, the difference among these groups was statistically significant (P<0.001). Abnormal vaginal bleeding is more common in CS than LMS, ESS, UES, AS and other uterine sarcoma, the difference was statistically significant (P=0.000, P=0.000, P=0.002, P=0.028, P=0.000).The morbidity of abdominal pain and abdominal distension was31.5%and16.7%respectively, the difference with abdominal distension was statistically significant (P=0.013). Compared with LMS, ESS, AS, abdominal distension of UES is more common, the difference was significant(P=0.006, P=0.02, P=0.016).In addition, the incidence of vaginal discharge is11.1%, the difference of different histological types was significant (P<0.001). Vaginal discharge in CS is more common than LMS and ESS, the difference was statistically significant (P=0.000, P=0.001). The difference of the incidence of vaginal discharge in AS and LMS, ESS was statistically significant (P=0.003, P=0.02).1.4Clinical stagesThe difference was statistically significant in clinical staging among different histological types (P=0.012).The clinical stages of CS and UES patients are higher than that of LMS, ESS.1.5Lymph node metastasisThere was significant difference in the metastasis of lymph nodes among different histological types (P=0.019). Lymph node metastasis rate in UES patients is much higher than other types of uterine sarcoma (42.9%).2. Ultrasound Findings67.8%of the patients with uterine sarcoma could show blood flow signals under ultrasound, the differences among different histological types was statistically significant (P<0.001), while LMS, UES, CS patients are more likely to explore blood flow signal.3. Analysis of survival and prognostic factors3.1Overall survivalThe1,2,5-year overall survival rates of162uterine sarcomas were84.5%,74.9%,63.9%.3.2Univariate analysis of prognosisAge, clinical stage, histological type were the single factor affecting the prognosis of patients with uterine sarcoma. The older the age, the later the clinical stage, the worse the prognosis of uterine sarcoma patients would be. ESS and AS patients got better prognosis compared with other types of uterine sarcoma patients.3.3Multiplicty of prognosisThe independent factors which affect uterine sarcomas’survival rate were clinical stages.Conclusion:1. The age and menstrual status are different between uterine sarcomas with different histological types. Most of the patients with LMS and ESS are below47.5years and pre-menopause, while most of CS and UES are above47.5years and post-menopause.2. The most common first clinical manifestation of uterine sarcomas is abnormal vaginal bleeding, followed by abdominal pain, abdominal distension and pelvic mass. The incidence of irregular vaginal bleeding is more common in CS patients than other types of uterine sarcoma, and vaginal discharge is also one common first symptom in CS and AS patients.3.The blood flow signals under ultrasound mean the tumor would be malignant.4. The preferred treatment of uterine sarcoma is surgery, but enlarged operation could not raise the survival rate.5Adjuvant chemotherapy after operation can improve survival rate of uterine sarcoma, endocrine therapy could raise survival rate in patients with ESS.6. Age, clinical stage, histological type and treatment were the single factor affecting the prognosis of patients with uterine sarcoma. Clinical stage and treatment were independent prognostic factors of uterine sarcoma. |
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