Studies Of The Clinicopathological Characteristics And Prognostic Relationship Of Endometrial Stromal Sarcoma

Objective:Given the low incidence and limitation of present treatment of endometrial stromal sarcoma hitherto,it is necessary to further analysis the clinicopathological characteristics of it and to investigate the express of VEGF-A?VEGFR-2?CD31 in it,in order to identify the relationship between VEGF-A?VEGFR-2?CD31 and prognosis as well as to provide theoretical basis of the pathogenesis,clinical diagnosis and the further research for gene therapy of endometrial stromal sarcoma.Methods:50 cases of endometrial stromal sarcoma were collected in the affiliated hospital of Qingdao university from 2010 to 2017.VEGF-A?VEGFR2?PVEGFR-2?CD31 were detected by the immunohistochemical method.And all the data were statistically analysed by the SPSS software.The survival was computed using the Kaplan-Meier method with difference determined by log-rank test.Multivariate analyses were performed with the Cox stepwise regression model.Results:The median age at diagnosis of endometrial stromal sarcoma was 48.8 years old,ranging from 24 to 77 years old;62%patients is of BIM more than 24 kg/m~2;18 cases were post-menopausal,accounting for 36%(18/50);the common primary symptom was irregular vaginal bleeding,accounting for 40%(20/50),the second watery vaginal discharge,the third postmenopausal bleeding;rarely with hypertension,diabetes,personal and family history of tumor;more than 90%patients undergo the hysterectomy and bilateral resection of uterus,46%(23/50)patients undergoing Pelvic Lymph Node Dissection,with lymph nodes matastasis accounting only for 13%(2/23);>1/2 deep myometrial invasion accounting for 58%(29/50),Vessel carcinoma embolus accounting for 26%(18/50);G3 was 80%(40/50),G1 was 20%(10/50)respectively.The high expression rate of VEGF-A?VEGFR-2?CD31 is 32%,30%,28%.None of VEGF-A?VEGFR-2?CD31 is of statistical significance to prognosis.The 3-year and 5-years survival rate of endometrial stromal sarcoma was 83.6%,79.2%;the average overall survival was 42 months(5 to 82 months).The 3-year disease-free survival rate was 81.8%.The 3-year survival rate for pationts with FIGO stage I-IV was 89.3%,85.7%,66.7%and60.0%.In univariate analysis,tumor grading and Ki67 were statistical significantly bound up with prognosis(P<0.05).In multivariate analysis,the tumor grading(P=0.001)and age(P=0.033)are independent prognostic factors of endometrial stromal sarcoma(P<0.05).Conclusion:The prognosis of endometrial stromal sarcoma is bound up with tumor grading and Ki67.The surgery method of hysterectomy and bilateral resection of uterus can lower the rate of local metastasis.Tumor grading and age in endometrial stromal sarcoma were independent prognostic factors.VEGF-A?VEGFR-2 is of some high expression in endometrial stromal sarcoma and may be one of the angiogenesis factors that can be targeted in the further study.