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目的探讨子宫肉瘤的临床特点及预后相关因素,以改善其生存率。方法对辽宁省肿瘤医院1984年2月至2008年8月收治的101例子宫肉瘤的组织学类型、临床特点、治疗方法及预后进行回顾性分析。结果 101例子宫肉瘤患者5年总生存率为46.5%。单因素分析显示:年龄≤52岁组的5年生存率为57.1%,>52岁组为36.5%,差异有统计学意义(χ2=5.915,P=0.003)。绝经前患者5年生存率为57.6%,绝经后患者为25.7%(χ2=9.332,P=0.002)。子宫平滑肌肉瘤5年生存率34.3%,恶性中胚叶混合瘤为16.7%,子宫内膜间质肉瘤为73.8%,三者比较差异有统计学意义(χ2=23.274,P<0.001)。Ⅰ期与Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为61.1%、36.4%、18.2%、0%,差异有统计学意义(χ2=9.428,P=0.009)。当子宫体积<妊娠3个月子宫时,5年生存率为65.2%,而≥3个月时为41.0%(χ2=4.178,P=0.041)。手术、手术+放疗+化疗、手术+化疗、手术+放疗者5年生存率分别为41.7%、62.5%、45.9%、44.4%,差异无统计学意义(χ2=4.390,P=0.375)。多因素分析显示:仅绝经状态、手术分期和病理类型3个因素与患者的预后有关,其中手术分期是影响患者预后的最重要因素(P=0.001)。结论绝经状态、手术分期、病理类型是影响子宫肉瘤患者预后的独立因素。
Objective To investigate the clinical characteristics of uterine sarcoma and prognosis related factors in order to improve its survival rate. Methods The histological type, clinical features, treatment and prognosis of 101 cases of uterine sarcoma in Liaoning Tumor Hospital from February 1984 to August 2008 were retrospectively analyzed. Results The 5-year overall survival rate of 101 patients with uterine sarcoma was 46.5%. Univariate analysis showed that the 5-year survival rate was 57.1% in patients aged ≤52 years and 36.5% in patients aged 52 years (χ2 = 5.915, P = 0.003). The 5-year survival rate was 57.6% in premenopausal patients and 25.7% in postmenopausal patients (χ2 = 9.332, P = 0.002). The 5-year survival rate of uterine leiomyosarcoma was 34.3%, malignant mesodermal mixed tumor was 16.7%, and endometrial stromal sarcoma was 73.8%. The difference was statistically significant (χ2 = 23.274, P <0.001). The 5-year survival rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 61.1%, 36.4%, 18.2% and 0%, respectively. The difference was statistically significant (χ2 = 9.428, P = 0.009). The 5-year survival rate was 65.2% when the uterus volume was <3 months pregnant, and 41.0% at ≥ 3 months (χ2 = 4.178, P = 0.041). The 5-year survival rates of surgery, surgery + radiotherapy + chemotherapy, surgery + chemotherapy and surgery plus radiotherapy were 41.7%, 62.5%, 45.9% and 44.4% respectively, with no significant difference (χ2 = 4.390, P = 0.375). Multivariate analysis showed that only menopausal status, surgical stage and pathological type were related to the prognosis of patients. The staging of surgery was the most important factor affecting the prognosis of patients (P = 0.001). Conclusions The menopausal status, surgical staging and pathological type are the independent factors affecting the prognosis of patients with uterine sarcoma.