子宫癌肉瘤41例临床病理分析

目的:探讨癌肉瘤的临床病理特征对预后的影响。方法:回顾分析2000年1月至2011年6月复旦大学附属妇产科医院收治的41例子宫癌肉瘤患者的临床病理特征,采用Kaplan-Meier生存分析和Cox回归多因素分析评价各因素对预后的影响,并比较肿瘤上皮成分及间叶成分与预后的关系。结果:患者的3年总生存率为57.5%,3年无瘤生存率为52.5%。单因素分析提示,FIGO分期(2009年)Ⅲ~Ⅳ期、深肌层浸润、宫颈间质侵犯、淋巴结转移与预后密切相关。Cox回归多因素分析提示,淋巴结转移(P=0.042,OR=3.375,95%CI为1.045~10.897)是影响预后的独立因素。肿瘤的上皮成分和间叶成分中p53表达无明显差异,上皮成分为非内膜样腺癌的总生存率低于内膜样腺癌(P=0.074);但不同的间叶成分预后无明显差异。结论:手术病理分期为晚期、病理提示深肌层浸润、宫颈间质侵犯、淋巴结转移等提示预后差;而淋巴结转移是影响预后的独立因素。癌肉瘤上皮成分和间叶成分可能为单克隆来源;上皮成分为影响肿瘤生物学行为的主导成分。

Uterine carcinosarcoma:a clinicopathological analysis of 41 cases

Objective: To investigate the prognostic effect of various clinicopathological features of uterine carcinosarcoma. Methods: Medical records of 41 patients with uterine carcinosarcoma between Jan. 2000 to June 2011 in Obstetrics and Gynecology Hospital of Fudan University were retrieved. Kaplan-Meier and Cox Regress were used to analyze the prognostic factors,as well as the relationship between the prognosis and carcinomatous or sarcomatous elements. Results: Three-year overall survival( OS) and disease free survival( DFS) were 57. 5% and 52. 5%,respectively. Advanced Federation International Gynecology and Obstetrics( FIGO) stage( Ⅲ ~ Ⅳ),deep myometrial invasion,cervical stromal involvement and lymph node metastasis were related to worse outcomes,while lymph node metastasis was an independent prognostic factor. Immunohistochemical expression of p53 in the epithelial and mesenchymal components was similar. A type of non-endometrioid carcinomatous element may indicate worse outcome compared with endometrioid carcinomatous element( P = 0. 074). Nevertheless,the sarcomatous component seemed to bear no relationship with the prognosis. Conclusion: Patients with advanced FIGO stage,deep myometrial invasion,cervical stromal involvement and lymph node metastasis have worse prognosis. The lymph node metastasis is an independent prognostic factor. Carcinosarcomas are monoclonal tumors,and the carcinomatous component might be the driving force.