| Background:Uterine smooth muscle tumors are a common disease of female genitalia,The World Health Organiza,In 2014,WHO classified uterine Smooth muscle tumors into leiomyomas and special subtypes and unterine malignant potent tumors,STUMP)and Uterine leiomyosarcoma(ULMS).Cellular uterine leiomyomas(CUL)is the most common specific type of uterine leiomyomas.In addition,some CULs have the characteristics of borderline tumors,which can develop distant metastasis and malignant transformation easily.Objective:Retrospective study is being conducted to investigate the clinical features of cellular uterine leiomyomas and the potential risk factors of postoperative recurrence and malignancy,in order to augment clinicians’comprehension of cellular-rich uterine leiomyoma’s clinical features and to promptly identify the possible danger of recurrence and malignancy of CUL,thus allowing for prompt treatment and prevention.Methods:From January 2012 to January 2022,patients who underwent surgical treatment in the Second Hospital of Keda for uterine fibroids and were pathologically diagnosed as CUL after surgery or had a history of nuclear tumor and a history of nuclear tumor and a history of nuclear tumor and a history of nuclear tumor and a pathology of CUL after surgery were collected and followed up.The patients were divided into no recurrence group,recurrence group and malignant change group.All patients meeting the inclusion criteria were followed up by telephone,text message,or regular outpatient follow-up.The shortest follow-up time was 3 months and the longest was 10 years.Follow-up will be available until September 30,2022.These patients were regularly followed up for gynecological examination or ultrasound examination,so as to know when the recurrence or residual fibroids were found after CUL surgery,whether there was a second operation,and whether the fibroids were malignant.At the same time,patients’age,symptoms,surgical methods,fibroid size,fibroid location,endometriosis,adenomyosis and other conditions were collected through inpatient and outpatient electronic medical record system and imaging reporting system.Finally,residual patients,patients with incomplete clinical data and patients with unknown fibroid recurrence without regular follow-up were excluded,and the patients meeting the inclusion criteria were collected.Statistical software was used to analyze the clinical data of patients.Results:1.A total of 1445 patients with cellular leiomyoma of the uterus were included in this study.Among them,there were 1174 patients with no recurrence,with an average age of 39.42 years.The average age of 228 patients in the relapse group was 35.80 years.The mean age of 43 patients in the malignant change group was 40.00 years.It was found that the overall trend of age of onset was similar among the three groups.The highest age of onset was 40-49 years old in the group with no recurrence of CUL,30-39 years old in the group with recurrence of CUL,and 4049 years old in the group with malignant degeneration of CUL.There was statistical difference in the overall age distribution among the three groups(H=66.98,P<0.001).The results showed that there were statistical differences between IICUL non-recurrence group and CUL recurrence group,and between CUL recurrence group and CUL degeneration group(P<0.05),but there was no statistical difference between CUL non-recurrence group and CUL degeneration group(P>0.05).2.The most common surgical indications in the three groups were menstrual changes and abnormal uterine bleeding.3.The surgical indications of patients in the three groups,including whether they were complicated with endometriosis,adenomyosis of uterus,benign degeneration of fibroids,and the primary surgical method were statistically analyzed,and there was no statistical significance(P>0.05).4.The incidence of multiple myoma in CUL recurrence group and CUL malignancy group was higher than that in CUL non-recurrence group.According to the statistical analysis of the number of fibroids A statistical analysis of fibroids revealed a significant disparity between the three groups(X~2=98.44,P<0.001).The incidence of multiple myomas in CUL recurrence and malignancy groups was greater than in CUL non-recurrence group.Moreover,the results indicated that there were statistically significant differences between CUL non-recurrence and CUL recurrence groups,as well as CUL non-recurrence and CUL degeneration groups(P<0.05);however,no statistical difference was observed between CUL recurrence and CUL degeneration groups(P>0.05).5.The incidence of fibroids with(largest)diameter of 5-10cm was the highest in the three groups.The incidence of(maximum)myoma diameter greater than 10cm in CUL malignancy group was higher than that in CUL non-recurrence group and CUL recurrence group.From the aspect of maximum fibroid diameter.A significant disparity was observed between the three groups(X~2=46.90,P<0.001);the results demonstrated a disparity between the CUL no recurrence group and the CUL malignant transformation group.No statistical distinction was observed between the CUL recurrence group and the CUL malignant transformation group(P<0.05),nor between the CUL no recurrence group and the CUL recurrence group(P>0.05).6.Intermural leiomyoma was the most common in all the three groups.The incidence of intermyowall leiomyoma in CUL malignant degeneration group was higher than that in CUL non-recurrence group and CUL recurrence group.According to the statistical analysis of the largest fibroid growth site,there were statistical differences among the three groups(X~2=16.39,P=0.003).The results showed that there were statistical differences between CUL no recurrence group and CUL malignant transformation group,CUL recurrence group and CUL malignant transformation group(P<0.05),but there was no statistical difference between CUL no recurrence group and CUL recurrence group(P>0.05).7.The statistical analysis of fibroids in special sites revealed a significant disparity between the three groups(X~2=98.01,P<0.001).The results indicated that CUL non-recurrence and CUL recurrence groups had statistically distinct results,as did CUL non-recurrence and CUL degeneration groups(P<0.05),yet no such difference was found between CUL recurrence and CUL degeneration groups(P>0.05).8.The statistical analysis of historical nucleoma revealed disparities between the three groups,with a correlation coefficient of 74.80 and a p-value of less than 0.001.Statistical disparities between the CUL non-recurrence and CUL recurrence groups,as well as the CUL degeneration group,were revealed by the results(P<0.05).No statistical disparity was observed between the CUL recurrence and degeneration cohorts(P>0.05).9.Binary logistic regression analysis:age of onset,number of fibroids,special site fibroids,and number of nucleoma were independent risk factors for postoperative recurrence of CUL.The number of fibroids,(maximum)diameter of fibroids,(maximum)site of fibroids and number of nucleoma were independent risk factors for postoperative malignant degeneration.Age of onset and(maximum)fibroid diameter were independent risk factors for postoperative recurrence and postoperative malignancy of CUL.Conclusions:1.About 90%of CUL patients develop the disease between 30and 50 years old.The most common surgical indications of CUL patients were menstrual changes and abnormal uterine bleeding.2.Independent risk factors for fibroid recurrence include:age of initial onset,number of fibroids≥2,fibroids located at special sites(broad ligament,cervix,uterine horn,etc.),and history of fibroid nucleus removal.Therefore,there is a higher probability of fibroid recurrence in CUL patients aged 30-39 years with the first onset,multiple fibroids,fibroids located at special sites(broad ligament,cervix,uterine horn,etc.),and fibroid nucleus removal≥2times.3.Independent risk factors for malignant degeneration of fibroids include:number of fibroids≥2,(maximum)diameter of fibroids,location of special sites(broad ligament,cervix,uterine horn,etc.),and number of nucleoma≥2 times.Therefore,the probability of malignant degeneration of fibroids is higher in CUL patients with multiple fibroids,(maximum)fibroid diameter>10cm,fibroids located at special sites(broad ligament,cervix,uterine horn,etc.),and fibroid nucleus removal≥2 times.4.Independent risk factors for malignant degeneration after fibroid recurrence include age of initial onset and(maximum)fibroid diameter.Therefore,there is a higher probability of malignant fibroid degeneration in CUL patients who are 40-49 years old at the first onset and whose(largest)fibroid diameter is greater than10cm after recurrence of nuclear tumor. |
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