| Objection: The main purpose of this study was to summarize the relevant data of patients with uterine sarcoma and to analyze their prognostic factors in an in-depth analysis,in order to determine the pathogenesis of uterine sarcoma.On this basis,it can effectively provide theoretical support for the prevention and treatment of uterine sarcoma and improve the treatment environment.Method: The paper selected a retrospective survey of 62 cases of uterine sarcoma in a hospital from 2006 to 2016 were investigated,not only for their age,pregnancy and childbirth,the first symptom statistics,and its surgical approach,whether chemotherapy and prognosis Research,in addition,also 2 years,5 years of follow-up analysis.Result: 1.Clinical features: 1.1 age of onset Of the 62 patients in this study,the average age of onset was 45.86±13.47 years and the median was 45 years.The average age of onset of u LMS,ESS,UUS,and other types of uterine sarcoma were 44.97±9.07 years and 42.68±11.34 years,respectively.,59.78±9.98 years old,51.31±13.82 years old.The age of onset of u LMS and ESS patients was younger,whereas UUS patients were older onset.There was a statistical difference(P<0.005).1.2 Clinical manifestations The main clinical manifestations of uterine sarcoma in this study were vaginal bleeding(48.4%,30/62),abdominal mass(24.2%,15/62),abdominal pain(6.5%,4/62),and vaginal fluid(3.2%,2 / 62).Patients with uterine leiomyosarcoma(LMS)The symptoms of vaginal bleeding were relatively low,and the symptoms of vaginal bleeding in endometrial stromal sarcoma(ESS)were relatively high,with statistical differences(P=0.008).The other clinical symptoms were not statistically different in different pathological types(P=0.21).1.3 Childbirth times Of the 62 patients in this study,26 had multiple delivery history(more than 2),24 had only one delivery history,and 8 had no birth history.By the chi-square test,the number of births had no effect on the incidence.1.4 Preoperative diagnosis The preoperative diagnosis of uterine sarcoma in this study was 33.87%(21/62).Among them,preoperative diagnostic curettage confirmed uterine sarcoma,preoperative diagnosis was uterine fibroids,and there were 10 cases of postoperative pathological diagnosis of uterine sarcoma.The misdiagnosis rate of uterine fibroids was 16.13%(10/62).1.5 tumor markers All 62 patients with uterine sarcoma received preoperative CA125 tumor markers,of which 12 patients had There was no significant increase in the elevation of CA125 among different pathological types of uterine sarcoma(P=0.094).1.6 Surgical staging In this study,of 62 patients with uterine sarcoma,44 patients with stage ?(70.97%)and 9 patients with stage ?(14.52%),7 patients with stage ?(11.29%)and 2 patients with stage ?(3.22%).According to statistics,there is no statistical difference in surgical staging between different pathological types of uterine sarcoma(P=0.307).2.treatment All 62 patients with uterine sarcoma underwent surgical treatment.Among them,28 cases were resection of the whole uterus and/or double adnexa,10 cases of pelvic lymphadenectomy were performed in the whole uterus and bilateral adnexectomy,and 10 cases of pelvic lymphadenectomy were performed.A total of 15 cases of omentum resection were performed.Patients and their families requested 4 cases of uterine lesion resection alone,uterus + double adnexectomy + pelvic lymphadenectomy + partial bladder and/or partial bowel resection(including appendectomy)in 5 cases.After surgery,18 patients received adjuvant chemotherapy.Chemotherapy regimens mostly use platinum-based chemotherapy combined with chemotherapy for 4-6 times.Five lymph node-positive patients received adjuvant radiation therapy during chemotherapy.Of the 62 patients with uterine sarcoma,34 underwent pelvic lymphadenectomy, including 12 patients with u LMS,19 patients with ESS,2 patients with UUS,and 1 patient with other types of uterine sarcoma.There were 5 cases of pathologically reported lymph node metastases,including 3 patients with u LMS and 2 patients with ESS.The lymph node metastasis rates were 9.1% and 9.5%,respectively.There was no statistical difference in lymph node metastasis in different pathological types.3.Recurrence of uterine sarcoma 52 Patients with uterine sarcoma were followed until 2016-12-31.A total of 15 patients died and 28 relapsed patients.3.1 recurrence site: In uterine sarcoma recurrence patients,simple pelvic recurrence: 12 cases of pelvic recurrence,recurrence rate(12/28),recurrence rate was 36.73%;simple distant metastasis: simple pulmonary metastases in 5 cases,simple bone metastases in 3 cases,simple liver metastases In 4 cases,1 case of mediastinal metastasis,the recurrence rate(13/28)was 42.85%,and the pelvic recurrence with distant metastasis rate(3/28)was 20.41%.The 5-year mortality rate was 66.1% in patients with pelvic recurrence,85.7% in patients with distant metastases,and 5-year mortality rate in patients with local recurrence and distant metastasis.Mortality was statistically different.3.2 Recurrence time: In 28 patients with recurrent uterine sarcoma,the average recurrence time was 20.67±23.77 months,and the median recurrence time was 12.00 months(6-1-20 months).11 cases relapse within 1 year.Five patients relapsed 1-2 years after surgery.Two cases relapsed in 2-5 years and 10 cases relapsed in more than 5 years.The relapse rate within 5 years was 81.8%,80.0%,66.7% and 0%,respectively.Using the chi-square test,the difference in mortality at different time points of recurrence was statistically significant(P<0.05).4.Recurrence related factors of uterine sarcoma The univariate analysis of the surgical stage,pathological type,range of surgery,lymph node metastasis,and postoperative adjuvant chemotherapy in patients with recurrent uterine sarcoma was performed.Surgical stage and pathological type are the main factors affecting recurrence.4.1 Surgical staging and recurrence rate: The recurrence rates of stage ?,stage ?,stage ?,and stage ? were 34.09%,66.7%,71.43%,and 100%,respectively.The difference was statistically significant(P=0.041).4.2 pathological type and recurrence rate: The recurrence rates of uterine leiomyosarcoma,endometrial stromal sarcoma, undifferentiated sarcoma,and other types of uterine sarcoma were 45.5%,28.6%,100.0%,and 75.0%,respectively.The difference in recurrence rates between the four groups was statistically significant(P=0.035).4.3 Range of Surgery and Recurrence Rate Sixty-two patients with uterine sarcoma underwent surgical treatment,including 28 cases of whole uterine and/or double adnexectomy,10 cases of pelvic lymphadenectomy with whole uterus and double adnexa and pelvic lymphadenectomy,total uterine and double adnexectomy,and pelvic lymph node dissection + Daewang.Membrane resection was performed in 15 cases.Patients and their family members required 4 cases of uterine lesion resection alone,uterus plus double adductectomy plus pelvic lymphadenectomy,and partial bladder and/or partial bowel resection(including appendectomy)in 5 cases.The recurrence rates were 33.3%,40.0%,53.6%,75.0%,and 33.3%,respectively.Statistical analysis showed that there was no significant difference in the recurrence rate between patients with different surgical methods(P=0.510).4.4 Pelvic lymphadenectomy and recurrence rate A total of 34 patients underwent pelvic lymph node dissection.According to statistics,the recurrence rate of patients undergoing pelvic lymphadenectomy was 47.1%;the recurrence rate of patients who did not undergo pelvic lymphadenectomy was 46.2%.Statistical analysis showed that the relapse of the two groups of patients.There was no statistically significant difference in the rate(P=0.945).4.5 postoperative chemotherapy and recurrence rate: Postoperative chemotherapy was performed in 18 patients and 42 patients without chemotherapy.The recurrence rate of patients undergoing chemotherapy was 33.3%,and the recurrence rate of patients without chemotherapy was 52.4%.Statistical analysis results showed that there was no significant difference in the recurrence rate between the two groups receiving chemotherapy(P=0.175).5.Prognostic analysis Kaplan-Meier analysis and Log rank logarithmic grade test were used to analyze the prognostic factors in patients with uterine sarcoma.The results showed that the pathological staging P=0.01 and histological type P=0.00 were the factors affecting the overall survival of uterine sarcoma patients.Rate factor.The following factors may have no significant relationship with the overall survival rate of uterine sarcoma: greater omentum resection(P=0.69),lymphadenectomy(P=0.26),and adjuvant therapy(P=0.573).Conclusion:First.The majority of uterine sarcoma recurrence within 2 years,the earlier the recurrence,the worse the prognosis,pelvic recurrence in uterine sarcoma recurrence accounted for 39.28%,distant metastasis accounted for 53.57%,of which the distant metastasis mainly lung,liver,bone metastasis;Sceond.It is suggested that pelvic lymphadenectomy is not significantly associated with postoperative recurrence and mortality;Third.It is suggested that postoperative chemotherapy and postoperative recurrence and mortality are of little significance. |
PDF Full Text Request