南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (09): 1299-.

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子宫恶性苗勒氏管混合瘤的临床病理特征及预后

朱安娜,关明飞,朱彦,李燕,周莉,李从铸,黄萍   

  • 出版日期:2016-09-20 发布日期:2016-09-20

Clinicopathological characteristics and prognosis of uterine malignant mixed Mullerian tumor

  • Online:2016-09-20 Published:2016-09-20

摘要: 目的探讨子宫恶性苗勒氏管混合瘤的临床特征、治疗方法及预后。方法收集汕头大学医学院附属肿瘤医院2003年3月 ~2015年6月收治的16例子宫恶性苗勒氏管混合瘤的临床资料进行回顾性分析。结果16例患者诊断时中位年龄58岁,其中 13例为绝经后患者。按FIGO分期(2009年),Ⅰa期7例,Ⅰb期3例,Ⅱ期1例,Ⅲa期3例,Ⅲc2期1例,Ⅳ期1例。15例患者术 前行子宫分段诊刮术,病理均取得恶性证据。13例患者入院时查血CA125,2例升高。16例患者总生存率75.0%,无复发生存率 68.8%,随访期超过3年的患者11例,3年生存率72.7%。行腹膜后淋巴结清扫术12例,2例复发;未行腹膜后淋巴结清扫术4例, 3例复发。术后接受化疗者13例,3例复发;未接受化疗3例,2例复发。接受术后放疗6例,1例复发;未接受术后放疗10例,4例 复发。Ⅰ~Ⅱ期11例,复发率18.2%;Ⅲ~Ⅳ期5例,复发率60%。结论术前行子宫分段诊刮术对子宫恶性苗勒氏管混合瘤有较 大的诊断价值,手术病理分期是重要预后因子。早期诊断、完整的手术分期、术后以铂类为基础的化疗联合放疗可提高子宫恶 性苗勒氏管混合瘤的生存率。

Abstract: Objective To evaluate the clinicopathological characteristics, treatment and prognosis of uterine malignant mixed mullerian tumor. Methods The clinical, pathologic and follow-up data of 16 patients with uterine malignant mixed Mullerian tumor treated in our hospital between March, 2003 and June, 2015 were analyzed. Results The 16 patients had a median age of 58 years at diagnosis, and 13 of them were postmenopausal. The number of patients with FIGO stage Ia, Ib, II, IIIa, IIIc2, and IV was 7, 3, 1, 3, 1, and 1, respectively. In 15 patients who received uterine segment diagnostic curettage, pathological examination all reported malignant results. Among the 15 patients having serum CA125 level test upon admission, 2 had elevated CA125 levels. The overall and disease-free survival rates of the 16 patients were 75% and 68.8%, respectively, and the 3-year survival rate of 13 patients who were followed up for at least 3 years was 72.7%. Two out of 12 patients receiving retroperitoneal lymph node dissection had had postoperative recurrence, as compared with 3 out 4 who did not had the operation; tumor recurrence was found in 3 out of 13 patients receiving postoperative chemotherapy, as compared with 2 out of 3 patients who did not have chemotherapy; tumor recurrence occurred in 1 out of 10 patients receiving radiotherapy, as compared with 4 out of 6 patients without radiotherapy. The recurrence rates in 11 patients with FIGO stage I-II was 18.2%, and that among the 5 patients with FIGO stage III-IV was 60.0%. Conclusions Uterine segment diagnostic curettage has a high diagnostic value for uterine malignant mixed Mullerian tumor. FIGO stage is the important prognostic factor for these patients, and early diagnosis, accurate surgical staging, platinum-based chemotherapy and postoperative pelvic radiotherapy are all associated with a better prognosis.