| Objective:Uterine sarcoma is rare and has poor prognosis,leading to insufficient literature and lack of consensus on its diagnosis and treatment.The aim is to explore the clinic-pathological characteristics and related prognostic factors of uterine sarcoma in this hospital by analyzing the clinical data of uterine sarcoma,excluding carcinosarcoma and provide references for its management.Materials and Methods:72 patients with uterine sarcoma who were treated in the Shandong Provincial Hospital between April 2007 and May 2018 were analyzed retrospectively.They have complete and reliable data.The clinic-pathological data,treatment and therapeutic outcomes of the patients were obtained through electronic medical record system,telephone follow-up and survey.The non-repetitive characteristics of the patients were collected to establish a systemic database,including the patient's age at diagnosis,pregnancy and delivery,pathological type,stage,etc.The variables were computed by univariate or multivariate analysis by SPSS 25.0 software.All tests were bilateral and p<0.05 was considered statistically significant.Results:1.Among the 72 patients,29 cases(40.3%)were diagnosed with uterine leiomyosarcoma,34 cases(47.2%)with endometrial stromal sarcoma and 11 cases(12.5%)with adenosarcoma by the histological classification.The age at diagnosis was mainly 40-60 years old(72.2%).The age of diagnosis and the number of deliveries among the three histological types were not significantly different(P>0.05).2.Abnormal uterine bleeding(63.9%),abdominal discomfort(40.3%)and lower abdominal mass(36.1%)were the common manifestations of uterine sarcoma.Preoperative diagnosis was mainly confirmed by curettage and biopsy(20 cases).The diagnostic rate was only 27.8%.35 cases presumed benign myoma,19 cases(54.3%)of which were only performed myomectomy in the first surgery.3.In this study,30 patients in stage I(57.7%)and 11 patients in stage ?-?(55%)were treated with surgery followed by chemotherapy.The recurrence and metastasis mainly occured in uLMS(66.7%).The main site of metastasis was lung(38.9%).4.The median follow-up time was 51 months,ranging from 2.5 to 155 months.20(27.8%)patients developed disease progression within 2 years.Survival curves were plotted using the K-M method.Overall survival at 3 and 5 years were approximately 82.8%and 80.7%,respectively.Univariate analysis showed that patients with LG-ESS histological type,stage ?-? have longer OS(overall survival)and PFS(progression free survival).Menopausal status affected OS but not PFS.Multivariate analysis exhibited that staging was closely correlated with OS and PFS.Compared with early stage(stage ?-?),patients with advanced stage(stage ?-?)had a higher risk of death(HR = 30.491,95%CI:8.646-107.536,P<0.05)and disease progression(HR = 12.095,95.0%CI:4.599-31.806,P<0.05).Compared with HG-ESS and UES histologic types,LG-ESS showed better prognosis(P<0.005).Compared with surgery alone,adjuvant treatment after surgery of uterine-limited disease didn't show any clinical benefit(P>0.05).Conclusions:1.The uterine sarcoma is characterized by nonspecific clinical features,lower preoperative diagnosis rate and unfavorable prognosis.In the process of clinical medical practice,we should take the diagnosis seriously.2.Stage is an independent risk factor for survival and disease progression of uterine sarcoma patients.Early identification,diagnosis and treatment are helpful to improve the outcome of patients.Uterine sarcoma is prone to recurrence and metastasis early,so follow-up should be extensive.3.The management of uterine sarcoma is challenging to us because of its rare occurrence,diverse histological types.The multi-agency,prospective studies for uterine sarcoma are greatly required to further investigate standard therapeutic schedule. |
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