Clinical analysis of uterine intravenous leiomyomatosis: A retrospective study of 260 cases

Peng, Jing; Zhong, Fangfang; Zhu, Yuemeng; Zhang, Mingxing; Zhang, Meng; Lu, Chong; Wang, Yumeng; Qi, Xingling; Wang, Congwen; Li, Guiling

doi:10.1111/jog.15013

Cited by 15 publications

(20 citation statements)

References 33 publications

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“…As IVL is associated with high estrogen expression, it would be intuitive to assume that ovarian preservation is not recommended, and several studies have suggested bilateral oophorectomy to reduce recurrence ( 53 , 261 , 270 ); however, there is still insufficient evidence to confirm this conclusion. Peng J. et al repoted a retrospective study of 166 IVL patients who accepted surgery treatment, similar to our findings, compared with total hysterectomy and bilateral salpingo-oophorectomy, total hysterectomy does not increase the risk of recurrence (odds ratio = 0.96, 95% CI 0.08–10.58, p = 0.96), but tumorectomy seems a high-risk factor of recurrence (odds ratio = 20.09, 95% CI 4.16–97.10, p < 0.01) ( 271 ).…”

Section: Discussionsupporting

confidence: 88%

Clinical features and prognostic factors analysis of intravenous leiomyomatosis

Chen

Zhang

et al. 2023

Front. Surg.

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BackgroundThe treatment and prognostic factors of intravenous leiomyomatosis (IVL) remain lacking systematic evidence.MethodsA retrospective study was conducted on IVL patients from the Qilu Hospital of Shandong University, and IVL cases were published in PubMed, MEDLINE, Embase and Cochrane Library databases. Descriptive statistics were used for the basic characteristics of patients. The Cox proportional hazards regression analysis was used to assess the high-risk factors related to the progression-free survival (PFS). The comparison of survival curves was performed by Kaplan–Meier analysis.ResultsA total of 361 IVL patients were included in this study, 38 patients from Qilu Hospital of Shandong University, and 323 patients from the published literature. Age ≤45 years was observed in 173 (47.9%) patients. According to the clinical staging criteria, stage I/II was observed in 125 (34.6%) patients, and stage III/IV was observed in 221 (61.2%) patients. Dyspnea, orthopnea, and cough were observed in 108 (29.9%) patients. Completed tumor resection was observed in 216 (59.8%) patients, and uncompleted tumor resection was observed in 58 (16.1%) patients. Median follow-up period was 12 months (range 0–194 months), and 68 (18.8%) recurrences or deaths were identified. The adjusted multivariable Cox proportional hazard analysis showed age ≤45 years (vs. >45) (hazard ratio [HR] = 2.09, 95% confidence interval [CI] 1.15–3.80, p = 0.016), and uncompleted tumor resection (vs. completed tumor resection) (HR = 22.03, 95% CI 8.31–58.36, p < 0.001) were high-risk factors related to the PFS.ConclusionPatients with IVL have a high probability of recurrence after surgery and a poor prognosis. Patients younger than 45 years and with uncompleted tumor resection are at higher risk of postoperative recurrence or death.

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Section: Discussionsupporting

confidence: 88%

Clinical features and prognostic factors analysis of intravenous leiomyomatosis

Chen

Zhang

et al. 2023

Front. Surg.

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“…14 Furthermore, disease recurrence is related to surgical type. 17 In the present study, age (P = 0.031) and surgical type (P < 0.001) were factors associated with disease recurrence. Disease recurrence was high in patients younger than 45 years and in those who underwent myomectomy.…”

Section: Ta B L Ementioning

confidence: 43%

“…8,18 However, recent studies have revealed that GnRH-a and antiestrogenic therapy cannot help reduce the postoperative recurrence of IVL. 17,18 In the present study, four patients were treated with GnRH-a, and no recurrence occurred.…”

Section: Ta B L Ementioning

confidence: 62%

Intravenous leiomyomatosis of the uterus: Preoperative and intraoperative assessment

2023

Intl J Gynecology & Obste

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ObjectiveTo assess factors influencing preoperative diagnosis and hemorrhage during surgery with uterine intravenous leiomyomatosis.MethodsThis retrospective single‐institution study used univariate analysis and multivariate models to investigate potential factors contributing to preoperative diagnosis and hemorrhage during surgery associated with intravenous leiomyomatosis in 135 patients from January 2012 to April 2022. Risk factors for disease recurrence were also investigated. The SPSS statistical analysis package was used for data analysis.ResultsPrevious myomectomy or fibroid ablation and tumor location on color Doppler were related to preoperative diagnosis (P = 0.031 and P = 0.003, respectively). Multivariate regression analysis demonstrated that lesions extending to the broad ligament were the only factors affecting preoperative diagnosis (odds ratio [OR] 5.383, 95% confidence interval [CI] 1.49–19.47). Univariate analysis showed that previous myomectomy or fibroid ablation (P = 0.017), tumor location (P = 0.027), and parauterine involvement (P = 0.014) were associated with intraoperative hemorrhage. Parauterine involvement was an independent risk factor for increased bleeding (OR 1.36, 95% CI 1.14–3.92). Six patients (4.4%) relapsed. The present study demonstrated that age (P = 0.031) and surgical type (P < 0.001) might be associated with disease recurrence.ConclusionsTreatment emphasis should focus on lesions extending to the broad ligament. Intraoperative bleeding associated with parauterine involvement should be stopped as effectively as possible.

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“…Yu et al 14 reported 10 patients with disease confined to the uterus who underwent hysterectomy and bilateral oophorectomy and had no recurrence during a median follow-up time of 49 months. Peng et al 15 reported 86 cases confined to the uterus who underwent hysterectomy with bilateral oophorectomy; only two patients experienced recurrence during a median follow-up of 26 months.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for post-operative recurrence or progression of intravenous leiomyomatosis

Zhang,

Yu,

Lang

et al. 2024

Int J Gynecol Cancer

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ObjectiveTo analyse the risk factors for post-operative recurrence or progression of intravenous leiomyomatosis and explore the impact of different treatment strategies on patient prognosis.MethodsPatients with intravenous leiomyomatosis who underwent surgery from January 2011 to December 2020 and who were followed for ≥3 months were included. The primary endpoint was recurrence (for patients with complete resection) or progression (for patients with incomplete resection). Kaplan-Meier survival analysis was used to analyse the factors affecting recurrence.ResultsA total of 114 patients were included. The median age was 45 years old (range 24–58). The tumors were confined to the uterus and para-uterine vessels in 48 cases (42.1%), while in 66 cases (57.9%) it involved large vessels (iliac vein or genital vein and/or proximal large veins). The median follow-up time was 24 months (range 3–132). Twenty-nine patients (25.4%) had recurrence or progression. The median recurrence or progression time was 16 months (range 3–60). Incomplete tumor resection (p=0.019), involvement of the iliac vein or genital vein (p=0.042), involvement of the inferior vena cava (p=0.025), and size of the pelvic tumor ≥15 cm (p=0.034) were risk factors for recurrence and progression. For intravenous leiomyomatosis confined to the uterus or para-uterine vessels, no post-operative recurrence after hysterectomy and bilateral oophorectomy occurred in this cohort. Compared with hysterectomy and bilateral oophorectomy, the risk of recurrence after tumorectomy (with the uterus and ovaries retained) was significantly greater (p=0.009), while the risk of recurrence after hysterectomy was not significantly increased (p=0.058). For intravenous leiomyomatosis involving the iliac vein/genital vein and the proximal veins, post-operative aromatase inhibitor treatment (p=0.89) and two-stage surgery (p=0.86) were not related to recurrence in patients with complete tumor resection.ConclusionIncomplete tumor resection, extent of tumor lesions and size of the pelvic tumor were risk factors for post-operative recurrence and progression of intravenous leiomyomatosis.

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Clinical analysis of uterine intravenous leiomyomatosis: A retrospective study of 260 cases

Cited by 15 publications

References 33 publications

Clinical features and prognostic factors analysis of intravenous leiomyomatosis

Clinical features and prognostic factors analysis of intravenous leiomyomatosis

Intravenous leiomyomatosis of the uterus: Preoperative and intraoperative assessment

Analysis of risk factors for post-operative recurrence or progression of intravenous leiomyomatosis

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