Clinical Pathological Characteristics And Prognosis Analyses Of Endometrial Stromal Sarcoma

Objective: In this study,the general data,serological examination and immunohistochemical expression of patients with different subtypes of endometrial stromal sarcoma were compared,the adverse prognostic factors affecting the survival of patients were discussed,and the serological examination methods for distinguishing endometrial stromal sarcoma from uterine leiomyoma were sought.It is in order to provide reference for improving preoperative diagnosis rate,selecting treatment methods and improving prognostic outcome.Methods: Clinical data of 72 patients with endometrial stromal sarcoma affiliated to Shengjing Hospital of China Medical University were retrospectively analyzed,and 72 patients with uterine leiomyoma were included as control group.Rank sum test and Chisquare test were used to compare the differences between the groups.Kaplan-Meier survival analysis and Log-rank test were used to analyze the prognostic factors.P<0.05 was considered statistically significant.Immunohistochemical method was used to detect the expression of related molecular markers.Results: Among the 72 patients,44 cases were low-grade endometrial stromal sarcoma,19 cases were high-grade endometrial stromal sarcoma,and 9 cases were undifferentiated uterine sarcoma.The main clinical manifestations were hypermenorrhea,the average age of onset was 48.44 years old,and 47 patients were not menopausal when onset.According to FIGO(2009)stage,44 patients were in stage I,4 were in stage II,12 were in stage III,9 were in stage IV,and 3 were in unknown stage.69 patients underwent surgery,and 25 underwent a second operation due to insufficient scope of the initial operation.Immunohistochemical results showed that the positive expression rate of Vimentin was the highest,followed by CD10,PR and ER.21 patients died.Age of onset,tumor size,neutrophil-to-lymphocyte ratio,CA125,tumor stage and histological type had an impact on the prognosis of the disease.Conclusion: The combined application of pelvic ultrasound,contrast-enhanced CT and contrast-enhanced MRI can improve the preoperative malignant detection rate of endometrial stromal sarcoma.Compared with uterine leiomyoma,the levels of neutrophil count,platelet count,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,DDimer and CA125 in endometrial stromal sarcoma were higher(P<0.05).The optimal cutoff value for neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio and CA125 were2.11,191.88 and 17.83U/ml,respectively.The adverse prognostic factors of endometrial stromal sarcoma include age of onset older than 50 years,tumor size bigger than 7cm,neutrophil-to-lymphocyte ratio greater than 2.1,CA125 positive,and late tumor stage.