Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas

Abstract

BACKGROUND The objectives of the current study were to determine the prognostic factors associated with disease‐specific survival (DSS) and to analyze the role of lymphadenectomy (LND) and oophorectomy in the management of uterine leiomyosarcomas (LMS). METHODS Data were abstracted from the Surveillance, Epidemiology, and End Results database (1988–2003). Kaplan‐Meier and Cox proportional hazards regression models were used for analyses. RESULTS The median age of the 1396 patients was 52 years. There were 951 patients (68.1%) with International Federation of Gynecology and Obstetrics (FIGO) stage I disease, 43 patients (3.1%) with stage II disease, 99 patients (7.1%) with stage III disease, and 303 patients (21.7%) with stage IV disease. Distribution by tumor grade included 87 patients with grade 1 tumors, 208 with grade 2, and 509 patients with grade 3 tumors. The 5‐year DSS rates for patients with stage I, II, III, and IV disease were 75.8%, 60.1%, 44.9%, and 28.7%, respectively. Lymph node metastases were identified in 23 of 348 patients (6.6%) who underwent LND. The 5‐year DSS rate was 26% in patients who had positive lymph nodes compared with 64.2% in patients who had negative lymph nodes (P < .001). Of 341 patients aged <50 years with stage I or II disease, 240 (70.4%) underwent oophorectomy. There was no difference in 5‐year DSS based on oophorectomy. On multivariate analysis, older age at diagnosis, more recent year of diagnosis, African‐American race, higher tumor grade, higher stage of disease, and lack of primary surgical treatment all were associated significantly with worse survival. CONCLUSIONS Independent predictors of DSS in patients with uterine LMS included age, race, stage, grade, and primary surgery. Oophorectomy was not found to have an independent impact on survival. Cancer 2008. © 2008 American Cancer Society.

Diagnostic and Prognostic Significance of p16, p53, and bcl-2 Expressions and Ki-67 Proliferation Index in Benign and Malignant Uterine Smooth Muscle Tumors

“…No consensus has been reached regarding the correlation between the clinical course of LMS and possible prognostic factors such as age, disease stage, tumor size, necrosis, vascular invasion, and mitotic index (2,9,(15)(16)(17). Most studies reported that tumor size and mitotic index are the most significant parameters for prognosis (2)(3)(4).…”

“…For quantitatively evaluating Ki-67 staining, the five most intensively stained areas were selected while screening HPF at 40× magnification, and the average of these values was used (16).…”

Uterine Sarcomas - Current Therapeutic Options

“…Carcinosarcomas re tumors with a high capacity of extension: 37% of patients present myometrail invasion, 17% present nodal involvement and almost 21% of patients present malignant cells in the peritoneal lavage cytology. (3,4,5) In almost all cases the presence of the distant metastases is due to the epithelial component of the carcinosarcoma.…”

“…Combining size tumor with the mitotic index, led to the classification of patients into three risk groups: low risk group (tumor size less than 100 mm and less than 10 mitoses / 10 high-resolution fields), medium-risk group (whether the tumor is larger than 100 mm, and no more than 10 mitoses / 10 fields) -risk of death 1.9 times higher, and high-risk group (tumor greater than 100 mm or a high index of mitosis) -risk of death by 5.3 times higher. (3,11,12) …”

Impact of adjuvant treatment on oncologic outcomes inpatients with stage I leiomyosarcoma of the uterus

“…However, debulking of any tumor outside the uterus should be a goal of the surgery since the most important prognostic factor is residual disease following primary surgery (1,4).…”