Leiomyosarcomas have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors: the result of a retrospective study of 423 cases of uterine sarcoma

Abstract

Objective To determine the survival data for the various tumour types of uterine sarcoma and determine the influence of various prognostic factors on survival. Design Retrospective analysis of all uterine sarcoma cases registered in the 15 year period 1967–1981. Setting West Midlands Regional Cancer Registry, serving a catchment area of 2.6 million women. Subjects 423 women registered as having a uterine sarcoma; 367 of these were associated with the two main histological types, leiomyosarcomas (LMS) and mixed mesodermal tumours (MMT). Main outcome measures Duration of survival was taken as the primary endpoint. Results The overall 5‐year survival for uterine sarcomas in this series was 31%, with the major prognostic indicator being tumour stage. Survival for mixed mesodermal tumours is similar to other sarcomas despite a tendency towards less differentiation, wider dissemination and a greater age of the patient at diagnosis. Multivariate analysis shows that for cases with similar stage, age and grade, mixed mesodermal tumours have a better prognosis than leiomyosarcomas. Conclusions These results demonstrate the danger of considering each variable in isolation when the relation between variables can lead to spurious significance or lack of significance because of the imbalances in the numbers between groups of prognostic importance. This study underlines the need for an adequate inspection of the infra‐abdominal contents at the time of hysterectomy for uterine fibroids.

Survival, patterns of spread and prognostic factors in uterine sarcoma: a study of 76 patients

“…Almost half of all patients in this series presented with Stage I disease (i.e., confined to the uterine corpus), but although this individual factor improved outcome, median survival for the series as a whole was only 22 months. This finding concurs with those in other studies (Salazar et al, 1978;George et al, 1986;DiSaia & Creasman, 1989;Olah et al, 1991Olah et al, , 1992. The largest documented series of uterine sarcoma is a retrospective epidemiological study of 423 patients by Olah and colleagues (1992); based on the West Midlands Regional Cancer Registry data; they found that 60% of patients presented with Stage I disease, with an overall survival of 31% at 5 years, and a median survival of 16 months.…”

“…Lack of residual disease following this initial surgery was a positive prognostic factor on univariate analysis both in this study and others (Salazar et al, 1978;Marchese et al, 1984;Olah et al, 1992), but when adjusted for tumour stage and grade this did not translate to an overall survival benefit. Again, this finding supports the concept of early and occult metastasis.…”

“…Sarcomas of the uterus are rare tumours which account for less than 3% of all female genital tract malignancies, and between 3 and 7% of malignant tumours of the uterine corpus (Olah et al, 1991(Olah et al, , 1992. They carry a poor prognosis, with an overall survival of under 50% at 2 years, even when presenting at an early stage (Salazar et al, 1978;Marchese et al, 1984;George et al, 1986;DiSaia & Creasman, 1989).…”

Prognostic Factors and Treatment Outcomes in 93 Patients with Uterine Sarcoma from 4 Centers in Turkey

“…In some studies, it was reported that MMMT had poorer prognosis than other types (Ghaemmaghami et al, 2008;Benito et al, 2009). Conversely, Olah et al reported that prognosis of LMS was poorer than that of MMMT (Olah et al, 1992). In our study, although there was no statistical difference between OS of different histological types; in numerical value, survival rate of LMS at 1 year-period was higher than that of MMMT (87.7% vs 72.4%), but after 5 yearperiod survival rate of MMMT was better than that of LMS (66.9% vs 41.9%).…”

Sarcomas Uterinos: Manejo Actual

“…Representan un grupo heterogéneo de neoplasias que se desarrollan del miometrio (leiomiosarcomas) y desde la mucosa uterina (sarcomas del estroma endometrial y sarcomas mesodér-micos mixtos) (2). Tienen un pronóstico pobre con una sobrevida global en general menor del 50% a 2 años, incluso en etapas tempranas de la enfermedad (3,4,5). Debido a la rareza de este tumor, así como también a su diversidad patológi-ca no existen estudios prospectivos randomizados fase III, por lo que las recomendaciones de tratamiento deben ser basadas en revisiones retrospectivas de pequeñas series, lo que asociado a su mal pronóstico hacen difícil su manejo clínico.…”