低惡性度子宮內膜間質肉瘤：單一機構經驗與文獻回顧

Low-grade endometrial stromal sarcoma: a single-institutional experience and review of the literature

本研究回顧性分析台北榮民總醫院於2000年1月至2020年6月間收治的26名低惡性度子宮內膜間質肉瘤（LGESS）患者，探討其臨床病理特徵、治療方式與預後因素。資 料收集項目包括診斷年齡、生育次數、更年期狀態、病理結果、FIGO疾病分期及 治療方式，並以Kaplan-Meier法估算無復發存活期（RFS）與整體存活期（OS），再用 log-rank檢驗比較各組間的生存差異。研究結果顯示，所有患者均接受子宮切除術為主要手術，其中88.5%同時施行雙側輸卵管卵巢切除，72.9%接受淋巴結清除， 69.2%於術後接受輔助治療。中位追蹤時間為80個月（範圍6至237個月），期間共有4 例（22.2%）發生復發，1例死亡，中位RFS與OS分別為59.0及62.0個月。在預後因素的分析上，FIGO第四期（P = 0.014）與生產次數超過4次（P = 0.001）均與較短的RFS有顯 著相關；腫瘤大小超過5公分雖有預後較差的趨勢，但未達統計顯著性（P = 0.32）。此外，手術方式、輔助治療類型、診斷年齡、更年期狀態及淋巴血管間隙侵犯等
因素，對整體存活結果並無顯著影響。本研究顯示，FIGO分期較晚及生育次數較多是影響LGESS患者預後的重要因子，惟受限於樣本數及回顧性研究設計，未來仍需更大規模的前瞻性研究加以驗證。

This retrospective study analyzed 26 patients with low-grade endometrial stromal sarcoma (LGESS) treated at Taipei Veterans General Hospital between January 2000 and June 2020, with the aim of evaluating clinicopathological characteristics, treatment approaches, and prognostic factors. Clinical data collected included age at diagnosis, parity, menopausal status, pathological findings, FIGO staging, and treatment modalities. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared across groups using the log-rank test. All 26 patients underwent hysterectomy as the primary surgical procedure; 88.5% had bilateral salpingo-oophorectomy, 72.9% underwent lymphadenectomy, and 69.2% received postoperative adjuvant therapy. The median follow-up was 80 months (range: 6-237 months), during which 4 recurrences (22.2%) and 1 death were recorded. Median RFS and OS were 59.0 and 62.0 months, respectively. Re-garding prognostic factors, advanced FIGO stage IV (P=0.014) and parity greater than 4 (P=0.001) were significantly associated with shorter RFS, while tumor size greater than 5 cm showed a trend toward poorer outcomes without reaching statistical significance (P=0.32). Surgical approach, type of adjuvant therapy, age at diagnosis, menopausal status, and lymphovascular space invasion did not significantly affect survival outcomes. These findings suggest that advanced FIGO stage and higher parity are important prognostic factors in LGESS, though larger prospective studies are needed to confirm these observations.