Clinical And Prognostic Analysis Of 80 Uterine Sarcomas

Background and Objective: Uterine sarcomas are a relatively rare group of gynecologic neoplasm with complicated histological types, most are leiomyosarcoma(LMS), endometrial stromal sarcoma(ESS), malignant mixed Mullerian tumor (MMMT), etc. Uterine sarcomas are difficult to achieve definite diagnosis before surgery with high misdiagnosis rate and poor prognosis. Surgery is the primary treatment, however uterine sarcomas are prone to metastasis in early stage and high in recurrence rate, adjuvant treatments are required to reduce recurrence and prolong survival time. This article is to analyze the clinical and pathologic features and factors affecting the prognosis of 80 patients with uterine sarcoma at the Fourth Affiliated Hospital of Hebei Medical University in recent 10 years and to provide useful information for promotion of treatment.Method: A retrospective analysis and a follow-up of 80 patients with uterine sarcoma treated at the Fourth Affiliated Hospital of Hebei Medical University from March 1999 to March 2008 were conducted. SPSS13.0was used for statistical analysis. Results:1 Clinical feature of histological types1.1 Age and MenstruationAmong these 80 uterine sarcomas, the mean age was 50.9±1.3 years (16-75 years), median age was 50 years. The mean age of MMMT was statistically higher than that of the other two types (P<0.05). Patients with MMMT are older, especially above 50 years.There were 32 postmenopausal patients, of which 21 cases were MMMT and it was statistically different with other types (P<0.05).Patients with MMMT are post-menopause.1.2 Clinical manifestation and SignsThe clinical manifestation of uterine sarcomas are not typical, abnormal vaginal bleeding was the most-seen first symptom (70%). Different histological types of uterine sarcomas differed in clinical manifestation, abnormal vaginal bleeding and vaginal discharge were more common in MMMT than LMS (P<0.05), there were no different between either MMMT or LMS and ESS (P>0.05).Uterine size of every histological types were similar, had no statistically significant (P>0.05).1.3 Preoperative diagnosis and Auxiliary examination 17 cases were pathologically confirmed before surgery with definite diagnosis rate 21.3% (17/80), of which 12 cases were MMMT, MMMT tend to be diagnosed relatively before surgery, there were statistically different (P<0.05). There were no statistically significant to be diagnosed by diagnostic curettage before surgery or tumor markers (P>0.05).Doppler sonography hint malignancy, there were statistically different (P<0.05), malignancy were more common in MMMT than LMS, ESS, and more LMS, ESS misdiagnosed as hysteromyoma.Blood signal of every histological types were similar, had no statistically significant (P>0.05).1.4 Staging and Tumor sizeThere were no statistically significant among staging of histological types (P>0.05).Tumor size of every histological types were similar, had no statistically significant (P>0.05).2 Follow-up data and Survival rate of uterine sarcomas Among 80 patients followed up, 1-111 months, 1-year survival rate was 79.9%, 2-year survival rate was 69.9%, 5-year survival rate was 66%.34 cases with LMS, 1, 2, 5-year survival rate were 91.2%, 84.7%, 81%; 15 cases with ESS, 1, 2, 5-year survival rate were 100%, 100%, 87.5%; and 31 cases with MMMT, 1, 2, 5-year survival rate were 61.3%, 37.4%, 37.4%.55 cases of stageⅠ, 1, 2, 5-year survival rate were 92.5%, 87.6%, 84.7%; 1 cases of stageⅡ, 1, 2, 5-year survival rate were 100%, 0%, 0%; 15 cases of stageⅢ, 1, 2, 5-year survival rate were 53.3%, 38.9%, 38.9%; and 9 cases of stageⅣ, 1, 2, 5-year survival rate were 33.3%, 11.1%, 11.1%.3 Relapse rateRelapse rate of every histological types and stagings were similar, had no statistically significant (P>0.05), there were statistically different among different treatment, adjuvant chemotherapy after surgery cut down relapse rate (P<0.05).4 Prognostic analysis of uterine sarcomas4.1 UnivariateThe factors which influenced survival rate were age, menstrual state, uterine size, histological types, tumor size, staging, treatment and modus operandi.4.2 MultiplicityMenstrual state and staging were statistically independent factors.Conclusion:1 Patients with MMMT are older, especially above 50 years and post-menopause.2 Abnormal vaginal bleeding was more common in uterine sarcomas. And abnormal vaginal bleeding and vaginal discharge were more common in MMMT than LMS.3 MMMT tend to be diagnosed relatively before surgery, but there were no statistically significant to be diagnosed by diagnostic curettage before surgery and tumor marker. Doppler sonography hint malignancy for MMMT.4 1, 2, 5-year survival rate were 79.9%, 69.9%, 66%. The survival rate of ESS and stageⅠwere higher.5 Survival rate were different for patients with different operation, enlarged operation could not raise the overall survival rate.6 Survival rate were different for patients with different treatment, adjuvant chemotherapy after surgery raise the overall survival rate and survival rate of patients with stagingⅢ, and cut down the relapse rate.7 The factors which influenced survival rate were age, menstrual state, uterine size, histological types, tumor size, staging, treatment and modus operandi. But only menstrual state and staging were statistically independent factors.