| Objective:To study the clinical characteristics,influencing factors and prognosis of recurrent uterine sarcoma.Methods:129patients with uterine sarcoma were treated in Qilu Hospital of Shandong University from December 1999 to December 2013.The clinical data of the 105 patients is collected for retrospective analysis.Among them,49 patients were recurrent patients and 56patients were without recurrence.The clinical features of the recurrent uterine sarcoma,recurrence sites,recurrence time,influencing factors,treatment and prognosis are analyzed.SPSS 19.0 software was used to analyse the clinical data.Chi-square test and t-test were performed.Univariate analysis used logistic regression and Kaplan-Meier.Multivariate analysis was performed using Cox proportional hazards regression model.For each analytical test method,P<0.05 was considered as the standard of statistical significance.Results:1.Recurrence site:Local recurrence rate was 36.73%,distant metastasis rate was 42.85%,the rate of local recurrence combined distant metastasis was 20.41%.The five year mortality rate was 66.1%in patients with local recurrence and 85.7%in patients with distant metastases.The five year mortality rate of patients with local recurrence combined distant metastas was 90.0%.(P<0.05)2.Recurrence time:The mean recurrence time was 20.67±23.7 months,the median time was 12 months.2 years recurrence rate was 63.27%,2 to 5 years recurrence rate was 24.99%,the rate of more than 5 years recurrence was 12.24%.3.Pathological character:①The recurrence rates of stage Ⅰ,stageⅡ,stage Ⅲ and stage Ⅵ were 28.4%,57.1%,88.9%and 100%.The recurrence rate is different significantly.②The recurrence rate of leiomyosarcoma was 56.8%,the recurrence rate of endometrial stromal sarcoma was 38.3%,the recurrence rate of uterine adenosarcoma was 27.3%,and all 3 patients with undifferentiated sarcoma recured.The difference was statistically significance(P<0.05).③Recurrence rate was not statistically significant for different lymph node status.④The recurrence rate of tumor diameter greater than 5cm(45.12%)was higher than that of tumor diameter less than 5cm(14.81%).It was of significant difference(P ＝ 0.001).4.Surgical scope:①There was no significant difference in the recurrence rate between different surgical scope.② There was no significant difference in the recurrence rate between the pelvic lymph node dissection and no pelvic lymphadenectomy(P = 0.095).5.Postoperative treatment measure:55 patients has postoperative chemotherapy,37patients has no adjuvant therapy,9 patients has postoperative endocrine therapy,3 patients has postoperative radiotherapy,and 3 patients has postoperative chemotherapy and radiotherapy.The recurrence rate in the four groups was not statistically significant(P>0.05).6.Treatment measure of recurrence:49 patients was divided into surgery group and non-surgical group.①The 5-year mortality rate was 57.1%in the operation group and 89.5%in the non-operation group,the difference was statistically significant(P ＝0.022).②The average over survival time after recurrence was 24.1 ± 31.25 months,the median survival time was 10 months.The median survival time in the operation group was 27 months,and the median survival time in the nonoperative group was 10 months.The difference was statistically significant(P = 0.01).7.1n univariate analysis,age,tumor size and stage were the influence factors of uterine sarcoma recurrence.In multivariate analysis,age and stage were the main factors influencing the recurrence.8.Age,recurrence time and treatment were the primary influencing factors of prognosis of patients with recurrence.Conclusions:1.Uterine sarcoma is prone to recurrence.The local recurrence rate and distant metastasis rate of uterine sarcoma were high.2.Recurrence usually occurred in 2 years,The ealier was the recurrence time,the worse was prognosis.3.Age and stage were the primary factors of recurrence,4.Age,recurrence time and treatment after recurrence are the main factors of prognosis of patients with recurrence.5.Uterine sarcoma has higher malignant degree and poorer prognosis,so effective adjuvant therapy to prevent recurrence and improve the prognosis is needed urgently. |
