Recurrence of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Systematic Review of the Literature

Abstract

Background: This study aimed to systematically review the existing literature on uterine smooth muscle tumor of uncertain malignant potential (STUMP) to provide information about characteristics and outcomes of patients and the risk factors for recurrence over a period of 60 years (1960–2021). Methods: According to PRISMA guidelines, we searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed (all fields) and Scopus (Title/Abstract/Keywords) databases (accessed on 1 January 2022). Relevant articles were obtained in full-text format and screened for additional references. The only filter used was the English language. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: Thirty-four studies, including 189 cases, were included. The median age was 43 years, and in 21.5% of cases there was a recurrence of the disease. Bivariate analysis showed a significant association between use of morcellation without bag and risk of recurrence (p = 0.001). Unprotected morcellation during demolitive or conservative surgery was independently associated with a higher risk of disease recurrence with a relative risk of 2.94 (p < 0.001). A significant progressive decrease in the recurrence rate was observed over time (r = −0.671, p = 0.008). The percentage of patients who underwent surgery followed by in-bag protected morcellation significantly increased after the publication of the U.S. Food and Drug Administration alert about the risk linked to this procedure (p = 0.01). Conclusions: Unprotected morcellation of the lesion is associated with the relapse of the disease. However, this clinical condition showed a drastic decrease over time. This could likely be due to the increased awareness by surgeons of the importance of customizing surgical treatment

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) Treated with Conservative Surgery: Systematic Review of Reproductive Outcomes

“…The recurrence rate reported in literature is very variable. STUMPs can recur either as STUMP or as leiomyosarcoma (in about 32% of cases), influencing the subsequent therapeutic choices, ranging from simple surgical excision to oncological treatments [20]. In our review, no case of recurrence as leiomyosarcoma has recorded.…”

“…Women with STUMP have signs and symptoms like those of uterine leiomyomas and leiomyosarcomas, i.e., pelvic pain, pelvic mass, abnormal uterine bleeding, compression of adjacent organs and secondary anemia, infertility, dysmenorrhea, and abnormal vaginal discharge [17][18][19]. About 45% of cases are asymptomatic and the uterine mass is diagnosed during a routine gynaecological examination [20].…”

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) ABOUT a CASE

“…The spectrum of uterine smooth muscle tumors varies from the benign variants represented by leiomyoma to the malignant equivalent, leiomyosarcoma [ [4] , [5] , [6] ]. A similar tumor that cannot be diagnosed with certainty as benign or malignant is called STUMP.…”

“…On the other hand, the choice between myomectomy and hysterectomy represents a real problem in the management of STUMP in young women, reconciling the risk of recurrence with fertility preservation [ 18 ]. Recurrence rates reported in the literature range from 7 % to 27 %, with a total recurrence rate of 11 % [ 3 , 4 , 5 ]. Treatment options for recurrence in addition to surgery include adjuvant chemotherapy, radiotherapy, and progestins GnRH analogs [ 19 ].…”

Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma

“…Despite the fact that they are considered to carry a low malignant potential, these tumors have the ability to recur and metastasize. The recurrence rates reported in the literature are between 7% and 27%, with a total recurrence rate of 11% [ 5 , 6 , 7 ].…”