Clinic Analysis Of 31 Cases With Uterine Carcinosarcoma

Background:uterine carcinosarcoma, also known malignant mixed mullerian tumor, malignant mesodermal mixed tumor, or metaplastic carcinoma is a rare and aggressive uterine malignancy with an incidence of fewer than 2 per 100,000 women per year. Although carcinosarcomas account for 40% of all uterine sarcoma, they are associated with>15% of uterine cancer-associated deaths. And which has a poor prognosis of this disease, there exit cognitive Limitations at present. It is difficult to early diagnosis, and there is no unified understanding about how to treat the uterine carcinosarcoma.Objective:To study the clinical profile, Medical imaging,Clinical pathology, Tumor markers, and treatment outcome of MMMT with multimodal therapy, and to provide the direction of standardized treatment or the early diagnosis.Methods:Retrospectively analyze the data about the 31 cases which was diagnosed with Uterine carcinosarcoma,received the initial surgical treatment in Qilu Hospital of Shandong University from March,1999 to Novembe,2014. The clinical data were reviewed including the age at diagnosis, Menopausal status, the age at Menopausal, symptoms, features of ultrasound, tumor markers,the extent of the surgery, postoperative pathology, Tumor size, postoperative adjuvant therapy. The 31 cases have completed follow-up data. The median follow-up was 40 months(range from 2 to 163 months). All statistical analyses were performed using the SPSS software. The method of survival analysis is the Kaplan-Meier and difference determined by log-rank test. The multi-factors analyses were performed with the Cox proportional hazards model. P<0.05 was the standard of statistical significance in each analytical test method.Results:These 31 uterine carcinosarcomas’ median age was 57 years(range from 15 to 73 years)and the average age was 57 years; 1 case was post-menopausal by the surgery and 20 cases were post-menopausal, accounting for 67.7% (21/31); the most common first symptoms of uterine carcinosarcomas was abnormal vaginal bleeding, whose rate was 93.5% (29/31); The clinic stage of FIGO with Ⅲ Ⅲ Ⅳ were 19,3,7,2.6 cases had just uterine and ovaries and fallopian tubes dissection,25 cases had routine lymph node dissection, of which 2 cases had lymph node metastasis, accounting for 8.0% (2/25). The 1,3,5-year overall survival rate of uterine carcinosarcoma were 77.4%、66.8%、53.6%, the average overall survival was 57 months(range from 2 to 163 months). The 1-year overall survival rate of uterine carcinosarcoma of FIGO stage Ⅰ, Ⅱ, Ⅲ, and IVwere 83.1%,66.7%,57.1%, O.The age, clinical stage, the tumor size, treatment were the single factor affecting the prognosis of patient of uterine carcinosarcoma(P<0.05).The multiplicity analysis of prognosis show that the independent factors were clinical stage and the age. Conclusion:The most common first symptoms of uterine carcinosarcoma was abnormal vaginal bleeding,and the most sign was hysterauxesis. The pre-operation Diagnostic curettage and Ultrasound in Obstetrics and Gynecology would be contributed to the diagnosis.The preferred treatment of uterine carcinosarcomas was surgey, There is no point to do the enlarged or lymph node dissection operation. The adjuvant therapy when the patient had finished operation can improve the patient survival rate. The prognosis of uterine carcinosarcoma may be related to age, FIGO stage, Treatment options, tumor size, and which the FIGO stage and The Age were independent prognostic factors of uterine carcinosarcoma. The Early diagnosis, perfect surgery, and adjuvant therapy will Prolong the survival rate of patients.