engleski

Prognostic parameters of survival in patients with malignant mesenchzmal tumours of the uterus

Background. Malignant mesenchymal uterine neoplasms are the most aggressive type of primary uterine tumors, with most of the patients dying within a few years of diagnosis. Thus, it would be very important to define prognostic factors for predicting their malignancy potential. Methods. Flow cytometric cell-cycle analysis (proliferative activity, DNA ploidy, and DNA-index) was performed on archival paraffin-embedded blocks from 80 patients with malignant mesenchymal uterine neoplasms (endometrial stromal sarcomas, malignant smooth muscle tumors and malignant mixed Mullerian tumors). Cox's proportional hazards regression model was used to assess relative effects of the follwing factors on the survival: clinical stage, mode of therapy, DNA ploidy+proliferative activity, DNA-index, histological type, cellularity, degree of atypia, mitotic activity and depth of myometrial invasion. Results. There were 9 low grade stromal sarcomas, 17 high grade stromal sarcomas, 8 smooth muscle neoplasms with uncertain malignant potential, 23 leiomyosarcomas, 16 homologous and 7 heterologous malignant mixed Mullerian tumors. In univariate analysis for stromal sarcomas, statistical significance was found for DNA ploidy+proliferative activity (p<0.001), histological type (p=0.005), and DNA-index (p<0.001). In multivariate analysis, DNA-index appeared the only significant parameter influencing patient survival (p=0.005). In univariate analysis for malignant smooth muscle neoplasms, statistical significance was detected for mitotic activity (p=0.049) and FIGO classification (p=0.021). In multivariate analysis, clinical stage appeared the only significant parameter influencing patients survival (p=0.032). In univariate analysis for malignant mixed Mullerian tumors, statistical significance was found for the depth of myometrial invasion (p=0.039), DNA-index (p=0.037) and clinical stage (p=0.013), but the multivariate analysis revealed that the depth of myometrial invasion (p=0.036) and clinical stage (p=0.025) were of statistical significance. Conclusion. The most powerful prognostic indicator for stromal sarcomas was the DNA-index, clinical stage for malignant smooth muscle neoplasms, and the depth of myometrial invasion and clinical stage for malignant mixed Mullerian tumors.

uterine sarcoma; MMMT; leiomyosarcoma; Stromal sarcoma; flow cytometry

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