Uterus sarkomlu 29 olgunun retrospektif analizi: Tek merkez deneyimi

Öz

Amaç: Uterus sarkomlu olguların evrelerine, histolojik tiplerine ve uygulanan tedavi yöntemlerine göre rekürrens ve sağkalım oranlarının ortaya konulmasıdır.

Yöntemler: Çalışmaya 2001- 2011 tarihleri arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Hastanesi Jinekoloji servislerinde uterin sarkom tanısı alan 29 olgu dahil edildi. Hastaların dosyalarına ulaşılarak retrospektif olarak sosyodemografik veriler, hastalığın tanı ve tedavi süreçlerinde uygulanan yöntemler araştırıldı. Hastalar aranarak hastalığın progresyonu, sağkalım süreleri, rekürrens durumları öğrenildi. Bulgular kayıt edilerek istatiksel olarak analiz edildi.
Bulgular: Hastaların tanı anındaki ortalama yaşı 51,2 (±13SD) olarak saptandı. Olguların %68,9’ u postmenopozal dönemde tanı aldı. Hastaların en sık (%72,3) başvuru şikayeti vaginal kanama idi. FIGO 2009’ a göre evrelenen hastaların %51,7’ sinin evre 1, %34,4’ ünün evre 3 olduğu saptandı. Olguların yirmiikisine (%75,8) total abdominal histerektomi(TAH) + bilateral salpingo ooferektomi (BSO)+ omentektomi + bilateral pelvik- paraaortik lenf nodu diseksiyonu (BPPLND) yapıldı. Ortalama tümör büyüklüğü 10,2(±8,5) cm olarak saptandı. Olguların %34,4 (n=10)’ ünde lenf nodu tutulumu mevcuttu. Operasyon sonrası ortalama yaşam süresi 3,2 yıl olarak hesaplandı. Verilerin toplandığı Aralık 2013 tarihine kadar oniki olgu (%41,37) eksitus oldu.

Sonuç: Uterus sarkomları erken evrede bile prognozu kötü olan tümörlerdir. Her bir histolojik tip ayrı ayrı değerlendirilmelidir. Adjuvan tedavilerin rolü tartışmalıdır. 

Anahtar Kelimeler

• Uterus sarkomları
• leimyosarkom
• sağkalım

Retrospective analysis of 29 cases with uterine sarcoma: A single center experience

Öz

Objective: To determine the recurrence and survival rates of uterine sarcomas according to stages, treatment methods, histological type.

Methods: In this study 29 patients were included who were diagnosed with uterine sarcoma at Zeynep Kamil Women and Children Diseases Hospital between 2001 and 2011. Demographic data of patients, treatment and diagnosis process were investigated retrospectively by accessing the file of patients. Disease progression, survival time, recurrence status was learned by calling. Results were analyzed statistically.

Results: Average age of patients were 51, 2 (± 13SD). Most of the patients were in postmenopausal (n=20, 68.9%). The most frequently (72.3%) complain was vaginal bleeding. 51.7% of patients were stage I and 34.4% of patients were stage 3 according to staging FIGO 2009. Twenty-two of the patients were treated with total abdominal hysterectomy (TAH)+ bilateral salpingo-oophorectomy (BSO)+bilateral pelvic and paraaortic lymphadenectomy (BPPLND) and omentectomy. Mean tumor size were 10, 2(±8.5) cm. 34,4% of patients (n = 10) patients had lymph node involvement. Respectively, after the operation, the average life expectancy of 3.2 years. Twelve patients (41.37%) died until data collected up to December 2013.

Conclusion: Uterine sarcomas have poor prognosis even at early stages. Each histological type must be evaluated separately. The role of adjuvant therapy is controversial. 

Anahtar Kelimeler

• Uterine sarcomas
• leimyosarcoma
• survival

Kaynakça

1. Lurain JR, Piver MS. Uterine sarcomas: Clinical features and
2. management. In Coppleson M (ed): Gynecologic Oncology: Fundamental Principles and Clinical Practice, 2d ed, p
3. Edinburgh, Churchill-Livingstone, 1992.
4. Nordal RR, Thoresen SO. Uterine sarcomas in Norway
5. -1992: incidence, survival and mortality. Eur J Cancer
6. ;33:907-911.
7. Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol
8. Obstet 2009;104:17-18.

9. Della Badia C, Karini H. Endometrial stromal sarcoma diag nosed after uterine morcellation in laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 2010;17:791-793.
10. Sagae S, Yamashita K, Ishioka S, et al. Preoperative diagnosis and treatment results in 106 patients with uterine sarcoma in Hokkaido, Japan. Oncology 2004;67:33-39.
11. Benoit L, Arnould L, Cheynel N, et al. The role of surgery
12. and treatment trends in uterine sarcoma. Eur J Surg Oncol
13. ;31:434-442.
14. Chauveinc L, Deniaud E, Plancher C, et al. Uterine sarcomas: the Curie Institute experience. Prognosis factors and adjuvant treatments. Gynecol Oncol 1999;72:232-237.
15. Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine
16. sarcoma 1989-1999. Gynecol Oncol 2004;93:204-208.
17. Thomas DB. The WHO Collaborative Study of Neoplasia
18. and Steroid Contraceptives: The influence of combined oral
19. contraceptives on risk of neoplasms in developing and developed countries. Contraception 1991;43:695-710.
20. Chu CS, Lin LL, Rubin SC. Cancer of the uterine body. DeVita, Hellman, and Rosenberg’s cancer: Principles & pracberg SA, editors. Philadelphia: WoltersKluwer/Lippincott Williams &Wilkins; 2008. pp 1543-1563.
21. Patsner B, Mann WJ. Use of serum CA-125 in monitoring
22. patients with uterine sarcoma. A preliminary report. Cancer
23. ;62:1355-1358.
24. Köhler G, Evert M. Uterine sarkome und misch tumoren.
25. st ed. Berlin: De Gruyter; 2009. pp 7-120.
26. Chander S, Ergun EL. Positron emission tomographic-computed tomographic imaging of a uterine sarcoma. Clin Nucl
27. Med 2003;28: 443-444.
28. Umesaki N, Tanaka T, Miyama M, et al. Positron emission
29. tomography with F-fluorodeoxyglucose of uterine sarcoma:
30. A comparison with magnetic resonance imaging and power
31. Doppler imaging. Gynecol Oncol 2001;80:372-377.
32. Abeler VM, Røyne O, Thoresen S, et al. Uterine sarcomas
33. in Norway. A histopathological and prognostic survey of a
34. total population from 1970 to 2000 including 419 patients.
35. Histopathology 2009;54:355 - 64.
36. Nam JH. Surgical treatment of uterine sarcoma. Best Pract
37. Res Clin Obstet Gynaecol 2011;25:751-760.
38. Gadducci A, Cosio S, Romanini A, Genazzani AR. The
39. management of patients with uterine sarcoma: a debated
40. clinical challenge. Crit Rev Oncol Hematol 2008;65:129-
41. -
42. Park JY, Kim DY, Kim JH, et al. The impact of tumor morcellation during surgery on the outcomes of patients with
43. apparently early low-grade endometrial stromal sarcoma of
44. the uterus. Ann Surg Oncol 2011;18:3453-461.
45. Greer BE, Koh WJ, Abu-Rustum N, et al. Uterine neoplasms. Clinical practice guidelines in oncology. J Natl
46. Compr Canc Netw 2009;7:498-531.
47. Kapp DS, Shin JY, Chan JK. Prognostic factors and survival
48. in 1396 patients with uterine leiomyosarcomas: Emphasis
49. on impact of lymphadenectomy and oophorectomy. Cancer
50. ;112:820-30.
51. Reed NS, Mangioni C, Malmströ m H, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and
52. II: An European Organisation for Research and Treatment
53. of Cancer Gynaecological Cancer Group Study (protocol
54. . Eur J Cancer 2008;44:808-818.
55. Kanjeekal S, Chambers A, Fung MF, Verma S. Systemic
56. therapy for advanced uterine sarcoma: a systematic review
57. of the literature. Gynecol Oncol 2005;97:624-637.
58. Sleijfer S, Seynaeve C, Verweij J. Gynaecological sarcomas. Curr Opin Oncol 2007;19:492-496.
59. Garrett A, Quinn MA. Hormonal therapies and gynecological cancers. Best Pract Res Clin Obstet Gynaecol
60. ;22:407-421.
61. Nordal RN, Kjørstad KE, Stenwig AE, Tropé CG. Leiomyosarcoma (LMS) and endometrial stromal sarcoma
62. (ESS) of the uterus. A survey of patients treated in the Norwegian Radium Hospital 1976 - 1985. Int J Gynecol Cancer
63. ;3:110-115.
64. Sutton G, Kavanagh J, Wolfson A, Tornos C. Corpus: Mesenchymal tumors. Principles and practice of gynecologic
65. oncology, 5th ed. Barakat R, Markman M, Randall ME, editors. Philadelphia: WoltersKluwer/Lippincott Williams &Wilkins; 2009. pp 733-761.
66. Koivisto-Korander R, Butzow R, Koivisto AM, Leminen
67. A. Clinical outcome and prognostic factors in 100 cases of
68. uterine sarcoma: experience in Helsinki University Central
69. Hospital 1990-2001. Gynecol Oncol 2008;111:74-81. doi:
70. 1016/j.ygyno.2008.06.002.
71. Einstein MH, Barakat RR, Chi DS, et al. Management of
72. uterine malignancy found incidentally after supracervical
73. hysterectomy or uterine morcellation for presumed benign
74. disease. Int J Gynecol Cancer 2008;18:1065-1070.