| Background & Objective: Uterine sarcoma(US)is a group of rare uterine malignancies that originate from the endometrium,uterine stromal,uterine smooth muscle and other intrauterine and extra-uterine tissues.Uterine sarcoma is classified into uterine leiomyosarcoma based on its histological characteristics.Leiomyosarcoma(LMS),endometrial stromal sarcoma(ESS),mixed malignant mullerian tumor(MMMT),and uterine adenosarcoma(UA)subtypes.Because of the lack of typical clinical signs and symptoms,and no specific tumor markers and typical imaging findings,the initial diagnosis of uterine sarcoma is difficult.The main treatment for the disease is complete uterine double appendages and(or)retroperitoneal lymph node dissection,adjuvant chemotherapy,hormone therapy,or radiotherapy can be appropriately selected.Uterine sarcoma has a poor prognosis and a high recurrence rate.This study collected clinical records of 43 patients with uterine sarcoma in Anhui Provincial Hospital Affiliated to Anhui Medical University and analyzed the characteristics of the clinical data,according to the clinical manifestations,laboratory and imaging findings,surgery of various histological subtypes of uterine sarcoma.Pathological data,treatment options,and prognostic differences analyze the clinical characteristics of each subtype of uterine sarcoma.Methods: The clinical data of 43 patients with uterine sarcoma who were treated at Anhui Provincial Medical University Affiliated Provincial Hospital from January2012 to January 2017 were collected.The statistical results were analyzed using SPSS20.0 software.Results: Analyze and summarize the clinical features of each subtype of uterine sarcoma(including age of onset and menopause,more common clinical symptoms and signs,laboratory and imaging auxiliary examination and preoperative initial diagnosis,postoperative staging and tumor diameter size),and surgery methods and adjuvant treatment options,survival and recurrence rates,and prognostic factors.Age and menopausal statusForty-three patients were aged from 15 to 70 years,with an average age of 49.72 ±1.70 years.The age of onset of each subtype was statistically significant(P <0.01).UA and MMMT were older and were more common in patients over 50 years of age(24 patients Patients ≥50 years of age).There were significant differences in menopausal status between subtypes(P <0.05).26 patients had menopause,most of patients with MMMT and UA had menopause,8 of 14 patients with LMS had menopause(57.14%),16 patients with ESS Six of the 6 patients had menopause(37.50%).All 8 MMMT patients were already with menopause(100%)and 5 UA patients had 4 menopause(80%),the difference was statistically significant(P <0.05).Clinical manifestations and signsThere were no differences in the clinical manifestations and signs of the subtypes(P>0.05).The most common abnormalities were abnormal vaginal bleeding,fluids,and lower abdominal masses(80%).Auxiliary examination and preoperative diagnosisPreoperative diagnosis of 19 cases,including 6 cases of MMMT confirmed before surgery,preoperative diagnosis was relatively high(P <0.05)..Pelvic ultrasound misdiagnosed as uterine fibroids,suggesting that malignant placeholder subtypes have differences(P <0.05),LMS and ESS are more likely to be misdiagnosed as uterine fibroids,MMMT is easier to diagnose by uterine malignancy.There was no significant difference in diagnostic curettage or hysteroscopy rates between preoperative subtypes(P> 0.05).There was a significant difference in the elevation rates of CA125 and LDH among subtypes(P <0.05).Clinical staging and tumor sizeDue to the small sample data,the study classified patients with stage II-IV into one group,all patients were divided into stage I and stage II-IV,the clinical stage of each subtype was no significant difference(P> 0.05),the size of each subtype of tumor The difference was statistically significant(P <0.05).Surgical methods and adjuvant treatment programsUterine sarcoma surgical approach to abdominal total hysterectomy double attachment based MMMT lymph node clearance rate higher(100%).Postoperative adjuvant chemotherapy were 88.37%.Survival and recurrence ratesAll 43 patients were followed up for 12 months to 60 months.The overall survival rates at 1 year,2 years and 5 years were 83.72%,72.09% and 60.47% respectively.14 LMS cases,The overall survival rates at 1 year,2 years and 5 years were 85.71%,71.43% and 57.14%;16 ESS cases,The overall survival rates at 1 year,2 years,5years were 87.50%,81.25%,75.0%;8 MMMT cases,The overall survival rates at 1year,2 years,5 years were 75.0%,62.5%,50.0%;5 UA cases,The overall survival rates at 1 year,2 years,5 years were 80.0%,60.0%,40.0%.26 Stage I cases,The overall survival rates at 1 year,2 years and 5 years were92.50%,80.77%,69.23%;7 Stage II cases,the overall survival rates at 1 year,2 years and 5 years were 71.43%,57.14% and 42.86%;3 Stage III cases,the overall survival rates at 1 year,2 years and 5 years were 66.67%,33.33%,33.33%;7 Stage IV cases,the overall survival rates at 1 year,2 years and 5 years were57.14%,42.86%,14.29%.The survival rates of patients with different subtypes of different clinical stages were significantly different,the higher the stage,the worse the prognosis,the prognosis of each subtype was also different(P <0.05),ESS better than other subtypes of uterine sarcoma slightly better prognosis.The recurrence rate of uterine sarcoma patients was higher.Among the 43 patients,8 patients(18.60%)had recurrent abdominal recurrences.Because of the limited sample data,the recurrence of uterine sarcoma could not be compared.Prognostic factorsAnalysis shows that age,menopausal status,clinical stage and lymph node metastasis are the factors affecting the prognosis of uterine sarcoma.Among them,clinical stage is the independent influencing factor of uterine sarcoma prognosis.Conclusions1 In each subtype of MMMT and UA patients with higher age,more common in patients over the age of 50 and menopause.2 Abnormal vaginal bleeding,fluid and the lower abdomen mass is the most common clinical manifestations of uterine sarcoma,MMMT more prone to vaginal bleeding than other subtypes,LMS and UA are more prone to abdominal mass than other subtypes.3 Each subtype of MMMT preoperative diagnosis rate is relatively high,the subtype of preoperative curettage and hysteroscopy rate was no difference.Ultrasound to identify all uterine sarcoma and uterine fibroids little significance,but the diagnosis of MMMT valuable.4 In this study,the overall survival rates of patients with uterine sarcoma at 1 year,2years and 5 years were 83.72%,72.09% and 60.47%,the survival rate was higher in LG-ESS and state I patients.5 The age of onset,whether menopause,postoperative clinical staging and lymph node metastasis are risk factors for the prognosis of uterine sarcoma.Staging is an independent risk factor for the prognosis of uterine sarcoma. |
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