Objective: The present study aims to evaluate the sociodemographic characteristics and clinical management of patients with uterine sarcoma. Methods: Retrospective analysis of 55 patients, who were diagnosed with uterine sarcomas between January 1, 2004–January 1, 2014, was performed. Sociodemographic characteristics, methods used in diagnosis and treatment processes were investigated by accessing the medical files of the patients. All patients were contacted by telephone to obtain information about disease progression and recurrence. Patients’ death reports were obtained from the national database of the Ministry of Health and the findings were analyzed statistically. Results: In this study, 55 cases of uterine sarcoma, of whom 31 carcinosarcomas (56.4%), 15 leiomyosarcomas (27.3%), six endometrial stromal sarcomas (10.9%) and three adenosarcomas (5.5%) were analyzed. The median age was 60.75±12.74 (min-max: 33–86). Fortythree (78.2%) patients were in postmenopausal period. Twenty-seven (47.3%) of these patients were diagnosed by endometrial sampling, 17 (30.9%) patients were diagnosed by frozen section, 11 (20%) patients were diagnosed by hysterectomy and one (1.81%) patient was diagnosed by myomectomy. Three patients had distant metastases at the time of diagnosis. According to FIGO (International Federation of Gynecology and Obstetrics) 2009, 65.5% of the patients were diagnosed at stage 1. 58.5% of the patients who underwent surgery were operated by gynecologist-oncologist. Total abdominal hysterectomy with bilateral salping-oopherectomy was performed in 52 patients (94.5%). Pelvic lymph node dissection was performed in 28 patients (51%). The mean survival time was 47 months in carcinosarcoma, 49.6 months in leiomyosarcoma, 84.8 months in endometrial stromal sarcoma and 68.7 months in adenosarcoma. Until the last date of collecting data, January 2019, 37 patients (67.3%) died. Conclusion: Uterine sarcomas are rare tumors with poor prognosis even in the early stages. Each histological type should be evaluated separately. Surgery is the main treatment method in uterine sarcoma. The role of adjuvant therapy is controversial.
Amaç: Bu çalışmadaki amaç, uterin sarkom tanısı alan hastaların sosyodemografik özelliklerini ve bu hastalara klinik yaklaşımı değerlendirmektir. Gereç ve Yöntem: Bu çalışmada Kadın Hastalıkları ve Doğum Kliniğimizde 1 Ocak 2004–1 Ocak 2014 tarihleri arasında uterin sarkom tanısı alan 55 hasta geriye dönük olarak irdelendi. Hastaların tıbbi dosyalarına ulaşılarak sosyodemografik veriler, hastalığın tanı ve tedavi süreçlerinde uygulanan yöntemler araştırıldı. Hastalar telefonla aranarak hastalığın progresyonu ve rekürrens ile ilgili bilgilerine ulaşıldı. Sağlık bakanlığı hasta ölüm bildirim raporlarına ulaşılarak hasta ölüm tarihleri belirlendi ve bulgular istatiksel olarak analiz edildi. Bulgular: Otuz bir karsinosarkom (%56.4), 15 leiomyosarkom (%27.3), altı endometrial stromal sarkom (%11), üç adenosarkom (%5.5) olmak üzere toplam 55 uterin sarkom tanılı hasta değerlendirmeye alındı. Ortalama yaş 60.75±12.74 (yaş aralığı 33–86) idi. Kırk üç hasta (%78.2) postmenopozal dönemde idi. Yirmi altı hasta (%47.3) endometrial örnekleme, 17 hasta (%31) frozen patolojik inceleme, 11 hasta abdominal histerektomi (%20) ve bir hasta abdominal miyomektomi (%1.8) tanısı aldı. Tanı anında üç hastada uzak metastaz saptandı. FIGO 2009’a göre evrelenen hastaların %65.5’inin evre-1 olduğu saptandı. Cerrahi operasyona giden hastaların %58.5’i jinekolog-onkolog tarafından ameliyat edildi. Elli iki hasta (%94.5) total abdominal histerektomi ve iki taraflı salpingooferektomi oldu. Yirmi sekiz hastaya (%51) pelvik lenf nodu disseksiyonu yapıldı. Ortalama sağkalım süresi karsinosarkomda 47 ay, leiomyosarkomda 49.6 ay, endometrial stromal sarkomda 84.8 ay, adenosarkomda 68.7 ay olarak hesaplandı. Verilerin toplandığı ocak 2019 tarihine kadar 37 hasta (%67.3) hayatını kaybetti. Sonuç: Uterus sarkomları nadir izlenen, erken evrede bile prognozu kötü olan tümörlerdir. Her bir histolojik tip ayrı ayrı değerlendirilmelidir. Uterus sarkomlarında temel tedavi cerrahi olarak kabul görmüştür. Adjuvan tedavilerin rolü tartışmalıdır.
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