Effect of postoperative adjuvant treatment in the therapeutic management of stage I, morcellated uterine leiomyosarcoma: A Korean multicenter study.

Abstract

e17106 Background: To evaluate the effectiveness of postoperative adjuvant treatment for morcellated, uterus-limited leiomyosarcoma in a multicenter setting. Methods: We included primary FIGO stage I uterine leiomyosarcoma patients treated between 2003 and 2016. All received one of the following morcellation methods: (1) intracorporeal morcellation using motorized device; (2) intracorporeal morcellation using surgical knife or electrocautery; and (3) vaginal morcellation. Patients’ survival outcomes were compared according to the implementation of postoperative adjuvant treatment. Results: In total, 55 patients were enrolled from 13 institutions, and 24 and 31 patients were assigned to surgery alone group and adjuvant treatment group, respectively. Characteristics including age, mass size, morcellation methods, and extent of surgery were similar between the two groups. On pathologic examination, there were no differences in degree of nuclear pleomorphism, necrosis, and lymphovascular space invasion. In adjuvant treatment group, 67.7%, 19.4%, and 12.9% received chemotherapy, concurrent chemoradiation therapy, and radiation, respectively. While the two groups showed similar overall survival ( P= 0.959) after a median follow up of 50.5 months, adjuvant treatment group showed a trend towards worse progression-free survival (PFS; 3-year survival rate, 78.2% vs. 46.1%; P= 0.060). However, in multivariate analyses, adjuvant treatment did not influence PFS (adjusted HR, 3.478; 95% CI, 0.659–18.367; P= 0.142). Confined to 17 cases where motorized morcellation device was used, surgery only and adjuvant treatment groups also showed similar PFS (3-year survival rate, 57.1% vs. 44.4%; P= 0.874). Conclusions: In FIGO stage I, morcellated uterine leiomyosarcoma, post-operative adjuvant treatment did not improve patients’ survival outcomes. Further prospective cohort studies are warranted.