Obstet Gynecol Sci.  2019 Mar;62(2):103-111. 10.5468/ogs.2019.62.2.103.

Prognostic factors for recurrence and survival in uterine leiomyosarcoma: Korean single center experience with 50 cases

• Paik ES
• Kang JH
• Kim J
• Lee YJ
• Choi CH
• Kim TJ
• Kim BG
• Bae DS
• Lee JW

• KMID: 2471682
• DOI: http://doi.org/10.5468/ogs.2019.62.2.103

Abstract

OBJECTIVE
The aim of this study was to determine the possible prognostic factors in patients with uterine leiomyosarcoma (LMS).
METHODS
This study retrospectively investigated 50 patients with uterine LMS treated at the Samsung Medical Center between 2001 and 2017. To analyze the prognostic significance of factors for recurrence-free survival (RFS), overall survival (OS), and survival after recurrence, the log-rank test and Cox proportional hazards model were used for univariate and multivariate analysis.
RESULTS
Of the 50 patients, 30 (60.0%) experienced recurrence and 16 (32.0%) died within a median follow-up period of 21 (range, 3-99) months. Multivariate analysis revealed that older age, absence of residual tumor after surgery, lower mitotic count, and a history of adjuvant radiotherapy at first treatment were significantly associated with better RFS. Presence of residual tumor after surgery and severe nuclear atypia were associated with poor OS. In the analysis of survival after recurrence, hematogenous recurrence, severe nuclear atypia, and presence of residual tumor at primary surgery were significantly associated with worse prognosis. Notably, residual tumor status at primary surgery was associated with RFS, OS, and survival after recurrence.
CONCLUSION
We demonstrated the possible prognostic factors for RFS, OS, and survival after recurrence for patients with LMS. These results may provide useful information for patients with LMS.

Keyword

Uterine neoplasm; Leiomyosarcoma; Prognostic factor; Survival; Recurrence

MeSH Terms

Follow-Up Studies
Humans
Leiomyosarcoma*
Multivariate Analysis
Neoplasm, Residual
Prognosis
Proportional Hazards Models
Radiotherapy, Adjuvant
Recurrence*
Retrospective Studies
Uterine Neoplasms

Figure

• 

  Fig. 1 Kaplan-Meier curve considering the influence of significant prognostic factors for recurrence-free survival (A, B), overall survival (C, D), and survival after recurrence (E, F).

Reference

1. Toro JR, Travis LB, Wu HJ, Zhu K, Fletcher CD, Devesa SS. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978–2001: an analysis of 26,758 cases. Int J Cancer. 2006; 119:2922–2930.

2. Felix AS, Cook LS, Gaudet MM, Rohan TE, Schouten LJ, Setiawan VW, et al. The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer. 2013; 108:727–734.

3. Foley OW, Rauh-Hain JA, Clemmer J, Clark RM, Hall T, Diver EJ, et al. Trends in the treatment of uterine leiomyosarcoma in the Medicare population. Int J Gynecol Cancer. 2015; 25:453–458.

4. D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010; 116:131–139.

5. Kim WY, Chang SJ, Chang KH, Yoon JH, Kim JH, Kim BG, et al. Uterine leiomyosarcoma: 14-year two-center experience of 31 cases. Cancer Res Treat. 2009; 41:24–28.

6. Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009; 104:177–178.

7. Leibsohn S, d'Ablaing G, Mishell DR Jr, Schlaerth JB. Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. Am J Obstet Gynecol. 1990; 162:968–974.

8. Leitao MM, Sonoda Y, Brennan MF, Barakat RR, Chi DS. Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus. Gynecol Oncol. 2003; 91:209–212.

9. Schwartz Z, Dgani R, Lancet M, Kessler I. Uterine sarcoma in Israel: a study of 104 cases. Gynecol Oncol. 1985; 20:354–363.

10. Zivanovic O, Jacks LM, Iasonos A, Leitao MM Jr, Soslow RA, Veras E, et al. A nomogram to predict postresection 5-year overall survival for patients with uterine leiomyosarcoma. Cancer. 2012; 118:660–669.

11. Kempson RL, Bari W. Uterine sarcomas. Classification, diagnosis, and prognosis. Hum Pathol. 1970; 1:331–349.

12. Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied logistic regression. 3rd ed. Hoboken (NJ): John Wiley & Sons;2013.

13. Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B. Uterine sarcoma: analysis of 13,089 cases based on Surveillance, Epidemiology, and End Results Database. Int J Gynecol Cancer. 2016; 26:1098–1104.

14. Kapp DS, Shin JY, Chan JK. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer. 2008; 112:820–830.

15. Pelmus M, Penault-Llorca F, Guillou L, Collin F, Bertrand G, Trassard M, et al. Prognostic factors in early-stage leiomyosarcoma of the uterus. Int J Gynecol Cancer. 2009; 19:385–390.

16. Abeler VM, Røyne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology. 2009; 54:355–364.

17. Dinh TA, Oliva EA, Fuller AF Jr, Lee H, Goodman A. The treatment of uterine leiomyosarcoma. Results from a 10-year experience (1990–1999) at the Massachusetts General Hospital. Gynecol Oncol. 2004; 92:648–652.

18. Mayerhofer K, Obermair A, Windbichler G, Petru E, Kaider A, Hefler L, et al. Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases. Gynecol Oncol. 1999; 74:196–201.

19. Seagle BL, Sobecki-Rausch J, Strohl AE, Shilpi A, Grace A, Shahabi S. Prognosis and treatment of uterine leiomyosarcoma: a National Cancer Database study. Gynecol Oncol. 2017; 145:61–70.

20. Leitao MM Jr, Zivanovic O, Chi DS, Hensley ML, O'Cearbhaill R, Soslow RA, et al. Surgical cytoreduction in patients with metastatic uterine leiomyosarcoma at the time of initial diagnosis. Gynecol Oncol. 2012; 125:409–413.

21. Anderson TM, McMahon JJ, Nwogu CE, Pombo MW, Urschel JD, Driscoll DL, et al. Pulmonary resection in metastatic uterine and cervical malignancies. Gynecol Oncol. 2001; 83:472–476.

22. Clavero JM, Deschamps C, Cassivi SD, Allen MS, Nichols FC 3rd, Barrette BA, et al. Gynecologic cancers: factors affecting survival after pulmonary metastasectomy. Ann Thorac Surg. 2006; 81:2004–2007.

23. Leitao MM, Brennan MF, Hensley M, Sonoda Y, Hummer A, Bhaskaran D, et al. Surgical resection of pulmonary and extrapulmonary recurrences of uterine leiomyosarcoma. Gynecol Oncol. 2002; 87:287–294.

24. Paik ES, Yoon A, Lee YY, Kim TJ, Lee JW, Bae DS, et al. Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors. J Gynecol Oncol. 2015; 26:270–276.

25. Greer BE, Koh WJ, Abu-Rustum N, Bookman MA, Bristow RE, Campos SM, et al. Uterine neoplasms. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2009; 7:498–531.

26. Nishigaya Y, Kobayashi Y, Matsuzawa Y, Hasegawa K, Fukasawa I, Watanabe Y, et al. Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma. J Obstet Gynaecol Res. 2019; 45:189–194.

27. Menczer J, Schreiber L, Berger E, Ben-Shem E, Golan A, Levy T. CA125 expression in the tissue of uterine leiomyosarcoma. Isr Med Assoc J. 2014; 16:697–699.