Uterine Leiomyosarcoma : 14-year Two-center Experience of 31 Cases
4
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose ; The aim of this study was to evaluate the clinicopathological characteristics of uterine leiomyosarcoma (LMS) and possible prognostic factors. Materials and Methods ; This study included 31 patients with histologically proven LMS at Samsung Medical Center and Ajou University Hospital between 1994 and 2007. The medical records and available histological slides were reviewed retrospectively. Results ; The median age was 46 years (range, 32∼63). The most common symptom was vaginal bleeding (11 patients, 35.5%). There were 23 patients with stage I, one patient with stage III, seven patients with stage IV disease. The median follow up time was 29 months (range, 1∼94). The most common recurrence site was lung (5 case), followed by pelvis and upper abdomen (2 case). Nine patients died of disease with a 5-year overall survival rate of 63%. Early tumor stage and mitotic count were the prognostic factor in univariate analysis (p<0.0001 and p=0.0031, respectively), but early tumor stage only was associated with prognosis in multivariate analysis (p=0.010 vs p=0.143). Adjuvant treatment for early stage disease did not decrease the recurrence rate (p=0.1075), but high mitotic count (15>10HPF) had a trend for disease recurrence in early stage LMS (p=0.0859). Conclusion ; Mitotic count less than 15/HPF in early stage may be related with longer progression-free interval, but we could not reach the conclusion that adjuvant therapy in early stage LMS be effective.
Abstract
Purpose ; The aim of this study was to evaluate the clinicopathological characteristics of uterine leiomyosarcoma (LMS) and possible prognostic factors. Materials and Methods ; This study included 31 patients with histologically proven LMS at Samsung Medical Center and Ajou University Hospital between 1994 and 2007. The medical records and available histological slides were reviewed retrospectively. Results ; The median age was 46 years (range, 32∼63). The most common symptom was vaginal bleeding (11 patients, 35.5%). There were 23 patients with stage I, one patient with stage III, seven patients with stage IV disease. The median follow up time was 29 months (range, 1∼94). The most common recurrence site was lung (5 case), followed by pelvis and upper abdomen (2 case). Nine patients died of disease with a 5-year overall survival rate of 63%. Early tumor stage and mitotic count were the prognostic factor in univariate analysis (p<0.0001 and p=0.0031, respectively), but early tumor stage only was associated with prognosis in multivariate analysis (p=0.010 vs p=0.143). Adjuvant treatment for early stage disease did not decrease the recurrence rate (p=0.1075), but high mitotic count (15>10HPF) had a trend for disease recurrence in early stage LMS (p=0.0859). Conclusion ; Mitotic count less than 15/HPF in early stage may be related with longer progression-free interval, but we could not reach the conclusion that adjuvant therapy in early stage LMS be effective.
참고문헌 (25)
- Echt G, "Treatment of uterine sarcomas", Cancer, 66, pp.35~39 (1990)
- Norris HJ ZC, "Mesenchymal tumors of the uterus, In: Blaustein editor. 2nd ed" (1982), Springer-Verlag
- Zaloudek C NH, "Mesechymal tumors of the uterus. In: Kuman RJ editor. 4th ed" (1993), Springer-Verlag
- Livi L, "Uterine sarcoma: twenty-seven years of experience", Int J Radiat Oncol Biol Phys, 57, pp.1366~1373 (2003)
- Major FJ, "Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study", Cancer, 71, pp.1702~1709 (1993)
- Leibsohn S, "Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas", Am J Obstet Gynecol, 162, pp.968~974 (1990)
- Mayerhofer K, "Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases", Gynecol Oncol, 74, pp.196~201 (1999)
- Berchuck A, "Treatment of uterine leiomyosarcoma", Obstet Gynecol, 71, pp.845~850 (1988)
- Schwartz Z, "Uterine sarcoma in Israel: a study of 104 cases", Gynecol Oncol, 20, pp.354~363 (1985)
- Kempson RL, "Uterine sarcomas. Classification, diagnosis, and prognosis", Hum Pathol, 1, pp.331~349 (1970)
- Fleming WP, "Autopsy findings in patients with uterine sarcoma", Gynecol Oncol, 19, pp.168~172 (1984)
- van Nagell JR Jr, "Adjuvant vincristine, dactinomycin, and cyclophosphamide therapy in stage I uterine sarcomas. A pilot study", Cancer, 57, pp.1451~1454 (1986)
- Giuntoli RL, 2nd, "Uterine leiomyosarcoma: present management", Curr Opin Oncol, 16, pp.324~327 (2004)
- Goff BA, "Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence", Gynecol Oncol, 50, pp.105~109 (1993)
- Giuntoli RL 2nd, "Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy", Gynecol Oncol, 89, pp.460~469 (2003)
- Sutton G, "Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study", Gynecol Oncol, 62, pp.226~229 (1996)
- Giuntoli RL 2nd, "Secondary cytoreduction in the management of recurrent uterine leiomyosarcoma", Gynecol Oncol, 106, pp.82~88 (2007)
- Blom R, "Leiomyosarcoma of the uterus: a clinicopathologic, DNA flow cytometric, p53, and mdm-2 analysis of 49 cases", Gynecol Oncol, 68, pp.54~61 (1998)
- Nola M, "Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus", Cancer, 78, pp.2543~2550 (1996)
- Larson B, "Prognostic factors in uterine leiomyosarcoma. A clinical and histopathological study of 143 cases. The Radiumhemmet series 1936-1981", Acta Oncol, 29, pp.185~191 (1990)
- Wu TI, "Prognostic factors and impact of adjuvant chemotherapy for uterine leiomyosarcoma", Gynecol Oncol, 100, pp.166~172 (2006)
- Bazzocchi F, "Clinical and pathologic prognostic features of leiomyosarcoma of the uterus", Tumori, 69, pp.75~77 (1983)
- Salazar OM, "Uterine sarcomas: natural history, treatment and prognosis", Cancer, 42, pp.1152~1160 (1978)
- Knocke TH, "Results of postoperative radiotherapy in the treatment of sarcoma of the corpus uteri", Cancer, 83, pp.1972~1979 (1998)
- Gadducci A, "Uterine leiomyosarcoma: analysis of treatment failures and survival", Gynecol Oncol, 62, pp.25~32 (1996)