Clinical value of pre-operative scoring systems to predict leiomyosarcoma: results of a validation study in 177 patients from the NOGGO-REGSA Registry

Abstract

ObjectivesBenign leiomyomas are the most common uterine tumors. In contrast, uterine leiomyosarcomas are malignancies with a poor prognosis due to difficulties in early diagnosis and inappropriate surgical treatment. Most often they are diagnosed incidentally after surgery performed for treatment of leiomyoma. As the appropriate surgical treatment is crucial for survival of the patient, there is a high demand to predict leiomyosarcoma pre-operatively. Available scoring systems to discriminate leiomyoma from leiomyosarcoma are based on retrospective studies with limited numbers of patients and are not implemented in routine clinical practice.MethodsThe aim of our study was to evaluate a recently published score—the pre-operative leiomyosarcoma (pLMS) score—to determine whether it would have been predictive of leiomyosarcoma in 177 patients from the NOGGO-REGSA study, a German register of histologically proven gynecological sarcoma detected during routine clinical investigation.ResultsThe threshold of the pLMS score for ‘leiomyosarcoma not probable’ (< −3) failed for 7.5% of the patients and the threshold ‘indicator for leiomyosarcoma’ (>+1) was true for 39.1% of the patients. 53.4% of the patients were attributed to the group ‘additional investigations are recommended’ (−3 to +1). The most relevant parameters in our analysis were suspicious sonography and rapid growth, but neither have been quantitatively defined.ConclusionIn our validation cohort, the pLMS score seems not to be a reliable tool to predict leiomyosarcoma and therefore we do not recommend its clinical implementation to identify leiomyosarcoma.

Correspondence on ‘Clinical value of pre-operative scoring systems to predict leiomyosarcoma: results of a validation study in 177 patients from the NOGGO-REGSA Registry’ by Condic et al

“…However, if the diameter had been 4 or 16 cm, the sub-scores would have been 0.97 or 3.87. Because menopause status was not directly available, an age threshold of 51 years was used as a definition 1. According to our data, 10% of all women would be classified incorrectly.…”

“…The recently published study by Condic and colleagues1 attempts an external validation of our preoperative leiomyosarcoma score (pLMS) 2. We would like to comment on their conclusion of ‘no definite recommendation for their clinical use’ 1. Similar to our analysis, the authors made use of retrospectively collected data obtained from a prospective registry.…”

“…The recently published study by Condic and colleagues1 attempts an external validation of our preoperative leiomyosarcoma score (pLMS) 2. We would like to comment on their conclusion of ‘no definite recommendation for their clinical use’ 1.…”

“…pLMS contains 12 essential variables 2. In the validation data, four variables (hypermenorrhea, dysmenorrhea, intermenstrual bleeding, and solitary tumor) were missing 1. Instead of a necessary exclusion of these cases, they were arbitrarily coded as 0.…”

“…Moreover, tumor diameter was missing in 44 cases of leiomyosarcoma (24.8%) and was set at a value of 8 cm,1 which corresponds to a sub-score of 1.94. However, if the diameter had been 4 or 16 cm, the sub-scores would have been 0.97 or 3.87.…”