| Objective:Retrospective comparison and analysis of clinical data from 38 patients with low-grade endometrial mesenchymal sarcoma(LG-ESS)and 116 patients with uterine leiomyoma,and discuss the pre-operative chemical parameters and variations in outcome prior to procedure from one group to another.To analyze the prognostic factors affecting LG-ESS patients,to improve gynecologists’ understanding of the disease,and to provide a basis for clinicians to improve the preoperative diagnosis rate of LG-ESS and improve the postoperative survival quality of patients.Methods:Collected 38 patients who attended the gynecology departments of the First Hospital of Shanxi Medical University,the Ninth Clinical Hospital of Shanxi Medical University,and the Yuncheng Central Hospital of Shanxi Medical University for surgical treatment and postoperative pathology confirmed LG-ESS between February 2017 and February2023.One hundred and sixteen patients who were hospitalized for surgical treatment during the same period and had postoperative pathology confirmed microuterine fibroids were randomly selected.Collection of LG-ESS and general clinical characteristics of patients with uterine fibroids before surgery: age at first diagnosis,age at menarche,whether menopause,clinical manifestations;laboratory tests: serum CA 125,lactate dehydrogenase(LDH),neutrophil count,lymphocyte count;pelvic ultrasound characteristics: maximum diameter of lesions,number of lesions,color Doppler ultrasound blood flow abundance,presence of cystic lesions;pelvic MRI: T1-weighted image(T1WI),T2-weighted image(T2WI),enhanced scan performance;postoperative adjuvant therapy or not;postoperative pathology;postoperative immunohistochemistry:estrogen receptor(ER),progesterone receptor(PR),proliferating cell nuclear antigen-67(Ki-67)and other information.Neutrophil/lymphocyte ratio(NLR)was calculated based on neutrophil and lymphocyte counts.The differences in the above indicators between the two groups were compared,and the factors affecting the prognosis of LG-ESS patients were analyzed.All data were collected and organized using EXCEL,and the data were processed using IMB SPSS Statistics 26.0 statistical software.Measurements conforming to a normal distribution the mean±standard error was indicated,and an independent sample t-test was used for inter-group comparisons;the data of surveys that did not conform to a normal distribution were expressed as the median description and the comparison between groups was performed using Mann-Whitney U test;Counting data are expressed in terms of frequency and percentage,intergroup comparisons this was conducted by chi-square test or Fisher’s exact probe method.Findings of the experiment diagnostic value of serum LDH and NLR for LG-ESS was analyzed using the subject receiver operating characteristic(ROC),and the maximum cut-off value was calculated.The COX risk proportional regression model was applied for univariate and Multifactorial analysis.Subsistence profiles were made using the Kaplan-Meier method,and the log-rank rank test was used for survival analysis.Differences were considered statistically meaningful at P<0.05.Results:1.38 patients with LG-ESS aged 27～65 years,mean age 48.7±8.4 years,median age49.5(43.0,53.0)years,clinical presentation: 52.7%(20/38)with abnormal vaginal bleeding,26.3%(10/38)with lower abdominal pain,10.5%(4/38)with abdominal mass/distension,2.6%(1/38)with pressure symptoms,7.9%(3/38)without symptoms.116 patients with uterine fibroids aged 23～63 years,mean age 44.2±8.8 years,median age44.0(38.0,50.0)years,clinical presentation: 37.1%(43/116)with abnormal vaginal bleeding,18.9%(43/116)with abdominal mass/distension.The clinical manifestations were:abnormal vaginal bleeding in 37.1%(43/116),lower abdominal pain in 18.9%(22/116),abdominal mass/distension in 13.8%(16/116),pressure in 17.2%(20/116),and asymptomatic in 116 patients with uterine fibroids aged 23-63 years,with a median age of44(43,53)years.13.0%(15/116)were asymptomatic,age(P=0.007)and clinical presentation of symptoms of compression(P=0.021)were visually different statistically between the two groups.2.Median LDH was 198.73(174.9,269.2)U/L and median NLR value was 3.6(3.0,4.0)in LG-ESS patients and median serum LDH was 171.8(156.7,187.9)U/L and NLR value was 2.1(1.5,2.8)in patients with uterine leiomyoma.LG-ESS patients had higher serum LDH and NLR values than patients with uterine fibroids(P<0.05).The area under the ROC curve of LDH is 0.751 and the critical value was 210.5 U/L.When LDH ≥210.5U/L,the sensitivity of LDH for diagnosing LG-ESS was 47.4% and the specificity was 89.7%;The area under the ROC curve of NLR is 0.849,and when NLR≥2.9 The sensitivity of NLR in diagnosing LG-ESS was 84.2% and the specificity was 76.7%.3.Preoperative pelvic ultrasound was perfected in 35 patients with LG-ESS and in116 patients with uterine fibroids.The median diameter of the largest LG-ESS lesion was10.7(6.8,18.2)cm,with 37.1%(13/35)clear borders,62.9%(22/35)unclear borders,and42.8%(15/35)cystic cavity;the median diameter of the largest uterine fibroid was 8.9(7.9,10.5)cm.The borders were clear in 63.8%(74/116),poorly defined or unclear in 36.2%(42/116),cystic lesions in 8.6%(10/116),and no cystic lesions in 91.4%(106/116).Compared with the two groups,there were statistical differences(P<0.001)in lesion size,border clarity(P=0.005),and the presence or absence of cystic lesions(P<0.001),with the former having larger lesions and most containing focal cystic lesions and the latter having clearer borders.4.Preoperative pelvic MRI was completed in 12 patients with LG-ESS,and pelvic MRI was completed in 116 patients with uterine fibroids before surgery.16.7%(2/12),high signal 83.3%(10/12),no significant enhancement 33.3%(4/12),significant enhancement 66.7%(8/12),uterine fibroid lesions were equal or low signal 67.2%(78/116),high signal 32.8%(38/116)in T1WI,equal or low signal 40.5%(47/116)in T2WI,high signal 59.5%(47/116)and high signal 59.5%(69/116),and in 89 cases,no significant enhancement was seen in 70.8%(63/89)and significant enhancement was seen in 29.2%(26/89)of the enhanced scans.There was no statistical difference in all parameters of pelvic MRI between the two groups(P>0.05).5.Univariate analysis: tumor stage(P=0.021),ER(P=0.016),PR(P=0.028)and Ki-67 index(P=0.015)were significantly associated with overall survival(OS)of patients;tumor stage(P=0.031),ovarian preservation(P=0.009),ER(P=0.017),PR(P=0.015),and Ki-67(P=0.037)were significantly associated with progression-free survival(PFS)in patients.6.COX multifactorial analysis: tumor stage(HR 39.153,95%CI 1.639-935.23,P=0.024)was an independent prognostic factor affecting OS,and tumor stage(HR 16.305,95%CI 1.019-260.77,P=0.048),ovarian preservation(HR 0.035,95%CI 0.002-0.805,P=0.036)was an isolated promotional effect of PFS.Conclusion:1.LG-ESS has a higher age of onset compared with uterine fibroids,but pressure symptoms are a more common clinical manifestation of uterine fibroids.2.serum LDH ≥ 210.5 U/LU/L and NLR ≥ 2.9 have a certain clinical auxiliary diagnostic value for LG-ESS compared with uterine fibroids.3.pelvic ultrasound of LG-ESS compared with uterine fibroids lesion diameter was larger,cystic lesions were more common than uterine fibroids,and the boundary of uterine fibroid lesions was clearer.4.tumor stage was an independent prognostic factor affecting OS,and tumor stage and preservation of ovaries were independent prognostic factors affecting PFS. |
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