摘要
目的探讨子宫内膜间质肉瘤患者的超声诊断和各临床病理因素与临床预后的关系。方法收集2013年5月—2018年6月由上海交通大学医学院附属仁济医院收治的24例子宫内膜间质内瘤(endometrial stromal sarcoma,ESS)患者的临床资料,记录并分析患者的临床表现、诊断和治疗情况,记录患者的病理分级、国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)临床分期结果、超声检查测量病变最大径,比较不同病理分级、FIGO临床分期、病变最大径患者的术后生存情况。结果患者发病年龄为22~70岁,中位发病年龄为52.5(36.0,61.5)岁,中位术后随访时间为27.5(8.0,47.0)个月,临床表现均无明显特异性。超声检查声像图可分为宫腔型、宫壁型和宫腔宫壁型。病理分级为LGESS 11例、HGESS 13例,LGESS患者中位年龄为50.0(33.0,53.0)岁,与HGESS者的59.0(41.0,63.5)岁的差异无统计学意义(Z=-1.537,P=0.134)。LGESS患者中肿瘤FIGO临床分期为Ⅰ和Ⅱ期11例、Ⅲ和Ⅳ期0例,HGESS患者中肿瘤FIGO临床分期为Ⅰ和Ⅱ期6例、Ⅲ和Ⅳ期7例;HGESS患者的肿瘤FIGO临床分期显著高于LGESS患者(P=0.006)。LGESS患者的中位病变最大径为50.0(42.0,75.0)mm,与HGESS者的103.0(63.5,143.0)mm相比差异有统计学意义(Z=-2.379,P=0.015)。LGESS患者平均术后生存时间为(54.357±3.368)个月,显著长于HGESS组的(29.744±6.769)个月(P=0.012)。FIGO临床分期Ⅰ和Ⅱ期患者(17例)平均术后生存时间为(54.667±4.523)个月,显著长于FIGO临床分期Ⅲ和Ⅳ期患者(7例)的(15.857±6.390)个月(P<0.001)。病变最大径≤80 mm患者(13例)的平均术后生存时间为(51.131±6.311)个月,显著长于病变最大径>80 mm者(11例)的(29.351±6.742)个月者(P=0.027)。结论ESS的病理分级和FIGO临床分期越高、病变最大径越大,患者术后的生存时间越短,应尽早明确诊断,选择最佳的手术方式,提高患者的生存率。
Objective To explore the relationship between ultrasound diagnosis and clinicopathologic factors and prognosis in patients with endometrial stromal sarcoma(ESS).Methods Twenty four patients with ESS admitted to our hospital from May 2013 to June 2018 were enrolled in this study.Their clinical characteristics such as pathologic classification,International Federation of Gynecology and Obstetrics(FIGO)clinical stage,lesion size and ultrasound findings were retrospectively analyzed.Kaplan-Meier survival analysis was performed to identify prognostic factors.Results The patients aged from 22 to 70 years old,and their median age of onset was 52.5(36.0,61.5)years.The mean duration of follow-up was 27.5(8.0,47.0)months.There were no specific clinical manifestations.The lesions were divided into uterine cavity type,uterine wall type and combined type by ultrasonography.There were 11 LGESS women and 13 HGESS women.There was no significant difference in the median age between LGESS and HGESS patients(50.0[33.0,53.0]vs.59.0[41.0,63.5],Z=-1.537,P=0.134).The FIGO stage of HGESS patients(6 cases with FIGOⅠ/Ⅱand 7 cases with FIGOⅢ/Ⅳ)was significantly higher than that of the LGESS(11 cases with FIGOⅠ/Ⅱ,P=0.006).The median maximum length of the mass was 50.0 mm(42.0,75.0 mm)in LGESS patients and 103.0 mm(63.5,143.0 mm)in HGESS patients(Z=-2.379,P=0.015).The mean survival time in LGESS patients was significantly longer than that in HGESS patients([54.357±3.368]months vs.[29.744±6.769]months,P=0.012).The mean survival time in 17 FIGOⅠ/Ⅱpatients was significantly longer than that in 7 FIGOⅢ/Ⅳpatients([54.667±4.523]months vs.[15.857±6.390]months,P<0.001).The mean survival time in 13 patients with the lesion major diameter≤80 mm was significantly longer than that in 11 patients with the lesion major diameter>80 mm([51.131±6.311]months vs.[29.351±6.742]months,P=0.027).Conclusions The pathologic grade,FIGO stage and lesion size are negatively related to the survival time of ESS patients.It is essential to confirm the diagnosis as early as possible and choose the best way of operation,so as to improve the survival rate of the patients.
作者
万晓燕
毛宇红
郑璐滢
狄文
WAN Xiaoyan;MAO Yuhong;ZHENG Luying;DI Wen(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《上海医学》
CAS
北大核心
2019年第11期674-679,共6页
Shanghai Medical Journal
基金
上海市重中之重临床医学中心和重点学科建设计划项目(2017ZZO2016).
关键词
肉瘤
子宫内膜间质
诊断
超声影像
预后因素
Sarcoma,endometrial stromal
Diagnosis
Ultrasound imaging
Prognosis factor
