Metastatic pattern of uterine leiomyosarcoma: retrospective analysis of the predictors and outcome in 113 patients

Abstract

ObjectiveTo describe metastatic pattern of uterine leiomyosarcomas (ULMS) and correlate it with clinical and histopathologic parameters.MethodsWe included 113 women (mean age, 53 years; range, 29 to 72 years) with histopathology-confirmed ULMS from 2000 to 2012. Distribution of metastases was noted from imaging by two radiologists in consensus. Predictors of development of metastases were analyzed with univariate and multivariate analysis. Impact of various clinical and histopathologic parameters on survival was compared using Log-rank test and Cox proportional hazard regression model.ResultsDistant metastases were seen in 81.4% (92/113) of the patients after median interval of 7 months (interquartile range, 1 to 21). Lung was most common site of metastases (74%) followed by peritoneum (41%), bones (33%), and liver (27%). Local tumor recurrence was noted in 57 patients (50%), 51 of whom had distant metastases. Statistically significant correlation was noted between local recurrence and peritoneal metastases (p<0.001) and between lung and other common sites of hematogeneous metastases (p<0.05). Age, serosal involvement, local recurrence, and the International Federation of Gynecology and Obstetrics (FIGO) stage were predictive factors for metastases. At the time of reporting, 65% (74/113) of the patients have died; median survival was 45 months. Stage, local recurrence, and age were poor prognostic factors.ConclusionULMS metastasizes most frequently to lung, peritoneum, bone, and liver. Local recurrence was associated with peritoneal spread and lung metastases with other sites of hematogeneous metastases. Age, FIGO stage and local recurrence predicted metastatic disease and advanced stage, older age and local recurrence predicted poor outcome.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma

“…Seventy‐one percent ( n = 5) of patients remain free of peritoneal disease, and interestingly, peritoneal recurrence was not seen even in the presence of distant metastases (Patient 1). Taking into consideration that the peritoneal cavity is the second most frequent site of metastasis (41%) after lung (74%), followed by bone (33%), and liver (27%) metastasis , this finding supports the use of CRS/HIPEC as a therapeutic locoregional approach which may significantly decrease the likelihood of developing recurrent intraperitoneal disease, and eventually may change the metastatic pattern of this malignancy.…”

Pulmonary metastasectomy in uterine malignancies: outcome and prognostic factors

“…The authors explained these results with a better selection of patients (none patient had more than four nodules) and with the R0 resection in most of the patients. Different factors have been reported to have a prognostic impact on survival: histology, age, number of nodules, presence of symptoms, length of DFI from the primary tumor, recurrence after pulmonary metastasectomy, stage of the first tumor and need of adjuvant therapy after gynecologic surgery (4,5,7,8,13,14). We have assessed several variables: short DFI (less than 2 4 m o n t h s ) a n d r e c u r r e n c e a f t e r p u l m o n a r y metastasectomy were the only independent factors affecting long-term survival.…”

“…The pattern of metastatic diffusion of UM is different between histologies; In fact EA and PSA commonly spread through the lymphatic pathway, whereas in UL and SCC hematogenous metastases are more frequent. The lung is the most common site of extrapelvic diffusion with an incidence ranging between 2.3% and 6.1% for EC and PSA (2-4); in patients with SCC and UL pulmonary recurrence occur in 10-20% and more than 60%, respectively (5)(6)(7)(8). Pulmonary metastasectomy for UM was successfully performed in 1930 by Torek (9) and currently this procedure is recommended in selected patients when the primary tumor is controlled or controllable with no further extrapulmonary spread, complete resection is feasible and no better therapy is available.…”

Current Concepts in Non-Gastrointestinal Stromal Tumor Soft Tissue Sarcomas: A Primer for Radiologists

“…Leiomyosarcomas commonly metastasize to the lung, bones, and liver, with intra-abdominal tumors also often involving the peritoneum, and surveillance scans should cover the chest, abdomen and pelvis (394154). Treatment options include conventional chemotherapy, trabectedin and pazopanib (3233).…”