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首页> 外文期刊>International journal of gynecological pathology: Official journal of the International Society of Gynecological Pathologists >Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family
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Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family

机译：区分子宫内膜间质肉瘤，低度和未分化子宫内膜肉瘤的诊断标准的预后价值，浸润性子宫内膜间质瘤家族中的两个实体

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The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms: noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important to note that the WHO 2003 does not define moderate atypia (an important differentiating diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance. Moreover, studies on reproducibility and additional prognostic value of other diagnostic features in large are lacking. Using strict definitions, we analyzed the agreement between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year recurrence-free survival rates for necrosis absent/inconspicuous versus prominent were 89% and 45% (P<0.001) and those for review-confirmed none/mild, moderate, severe atypia were 90%, 30%, and <20% (P<0.00001). Therefore, cases with moderate/severe atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic values (Cox regression). Once these features were taken into account, no other feature had an independent additional prognostic value, including mitotic count. Using "none/mild atypia, necrosis absent/inconspicuous" as ESS, low grade versus "moderate/severe atypia present or necrosis present" as UES resulted in 68 ESS, low grade and 23 UES cases with disease-specific overall mortality-free survival of 99% versus 48% (P<0.00001, hazard ratio=45.4). When strictly defined microscopic criteria are used, the WHO 2003 diagnoses of ESS, low grade and UES are well reproducible and prognostically strong.
机译：世界卫生组织（WHO 2003）识别3种子宫内膜间质瘤：非侵入性子宫内膜间质结节和2种侵入性肿瘤，子宫内膜间质肉瘤（ESS），低度和未分化子宫内膜肉瘤（UES）。重要的是要注意，WHO 2003没有定义中度非典型性（对ESS，低度和UES的重要区分诊断标准），也没有讨论其意义。而且，还缺乏对其他诊断特征的可重复性和附加预后价值的研究。使用严格的定义，我们分析了91例浸润性子宫内膜间质瘤（IESN）的常规和专家评审坏死与核型异型之间的一致性。 91名IESN患者的5年和10年无复发总生存率分别为82％和75％。坏死可很好地再现，核非典型性也可很好地再现。缺失/不明显与不明显的坏死的10年无复发生存率分别为89％和45％（P <0.001），经审查确认为无/轻度，中度，重度异型的患者的10年无复发生存率分别为90％，30％和< 20％（P <0.00001）。因此，中度/重度非典型性病例应合并在一起。核非典型性和坏死具有独立的预后价值（Cox回归）。一旦考虑了这些特征，就没有其他特征具有独立的预后价值，包括有丝分裂计数。使用“无/轻度非典型性非典型，无坏死/不明显”作为ESS，低度与“中等/重度非典型性严重或存在坏死”作为UES导致68例ESS，低度非典型性和23例UES患者具有疾病特异性的总体无死亡率生存99％与48％（P <0.00001，危险比= 45.4）。当使用严格定义的显微镜标准时，WHO 2003对ESS，低品位和UES的诊断具有良好的可重复性和预后性。

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