A nomogram to predict postresection 5‐year overall survival for patients with uterine leiomyosarcoma

Abstract

BACKGROUND The clinical course of patients with uterine leiomyosarcoma (LMS) is difficult to predict with the currently available categorical staging systems of the American Joint Committee on Cancer (AJCC) and the International Federation of Gynecology and Obstetrics (FIGO). The objective of the current study was to develop and validate a novel, clinically relevant, individualized prognostic model for patients with uterine LMS. METHODS Patients with uterine LMS who presented at the authors’ institution from 1982 to 2008 were analyzed. The nomogram model was chosen based on the clinical evidence and statistical significance of the predictors, including age at diagnosis, tumor size, histologic grade, uterine cervix involvement, extrauterine spread, distant metastases, and mitotic index. Five-year overall survival (OS) was the predicted endpoint. The concordance probability (CP) was used as a predictive accuracy measure and compared with the CP of current staging systems. The model was internally validated using 200 bootstrap samples to correct for over fitting. RESULTS One hundred eighty-five of 270 patients were eligible for the nomogram analysis. The median follow-up was 5.4 years, and the median OS was 3.75 years (95% confidence interval, 3-6 years). The CP of the newly developed nomogram was 0.67 (95% confidence interval, 0.63-0.72). This was superior to predictions based on AJCC and FIGO staging. The bootstrap-validated CP was 0.65 with good calibration accuracy. CONCLUSIONS The authors developed and internally validated a uterine LMS-specific nomogram to predict 5-year OS. This novel, individualized prognostic model outperforms traditionally used categorical staging systems and may be useful for patient counseling and for better selection of patients for adjuvant therapy trials.

Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications

“…Since then, several nomograms have been developed, including histology-specific nomograms for liposarcomas 29 and synovial sarcomas, 30 site-specific nomograms for both extremity 31,32 and retroperitoneal sarcomas, 22,33,34 and also uterine leiomyosarcomas. 35 Among these nomograms, the 'Sarculator' (http://www.sarculator.com/) is a freely available online resource with embedded nomograms for retroperitoneal 22,36 and extremity 32 sarcomas. This prognostic tool predicts distant metastasis-free and overall survival at 5 and 10 years after surgery for the primary tumour for extremity STS and at 7 years for retroperitoneal tumours.…”

Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

“…Thus, inquiring about the clinical history, especially about progestin intake may be very helpful in the correct interpretation of a uterine smooth muscle tumor. A third system has been developed focusing on patient 5-year outcome based on specific parameters that include age at diagnosis, tumor size, histologic grade, mitotic index, cervical involvement, extrauterine spread, and distant metastases, 8,9 which appears to have been validated using external cohorts. 10 As immunohistochemistry (mostly p16 and p53), and molecular tools including MED12 mutations have currently a very limited role in the classification of smooth muscle tumors as benign or malignant, morphologic examination remains the cornerstone in the diagnosis of these tumors.…”

Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma

“…Patients in the morcellation cohort are mostly younger at diagnosis, but had a worse outcome. However, Zivanovic, et al, associated younger age with better outcome in ULMS [18]. Adjusting our results for age alone, the group of patients that received morcellation still had a better outcome compared to the non morcellation group as far as survival and risk of recurrences are concerned.…”