Prognostic Factors and Survival in Patients Treated Surgically for Recurrent Metastatic Uterine Leiomyosarcoma

Abstract

Background. Uterine leiomyosarcoma (LMS) is a rare diagnosis, which is seldom cured when it recurs with metastatic disease. We evaluated patients who present with first time recurrence treated surgically to determine prognostic factors associated with long-term survival. Methods. Over a 16-year period, 41 patients were operated on for recurrent uterine sarcoma. Data examined included patient age, date of initial diagnosis, tumor histology, grade at the initial diagnosis, cytopathology changes in tumor activity from the initial diagnosis, residual tumor after all operations, use of adjuvant therapy, dates and sites of all recurrences, and disease status at last followup. Results. 24 patients were operated for first recurrence of metastatic uterine LMS. Complete tumor resection with histologic negative margins was achieved in 16 (67%) patients. Overall survival was significantly affected by the FIGO stage at the time of the initial diagnosis, the ability to obtain complete tumor resection at the time of surgery for first time recurrent disease, single tumor recurrence, and recurrence greater than 12 months from the time of the initial diagnosis. Median disease-free survival was 14 months and overall survival was 27 months. Conclusion. Our findings suggest that stage 1 at the time of initial diagnosis, recurrence greater than 12 months, isolated tumor recurrence, and the ability to remove ability to perform complete tumor resection at the time of the first recurrence can afford improved survival in selected patientsat the time of the first recurrence can afford improved survival in selected patients.

The Prognostic Value of C-Reactive Protein Serum Levels in Patients with Uterine Leiomyosarcoma

“…Zivanovic et al . showed that FIGO stage does not perform well in terms of predicting overall survival (OS) in patients with ULMS [ 4 – 6 ]. C-reactive protein (CRP) is a readily available and cheap laboratory parameter, that is widely used in clinical routine as the most important acute phase serum protein to monitor infection.…”

Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas

“…The optimal treatment for recurrent uterine sarcomas remains unclear. These tumors are relatively chemoand/or radio-resistant, and certain studies have previously evaluated the effectiveness of SCS in patients with recurrent uterine sarcomas (11,13,14).…”

“…SCS for patients who have pulmonary recurrent disease has been reported to lead to improved survival, particularly in those with unilateral disease, a smaller number of resected metastases (<3), a smaller tumor (<3 cm) and a longer DFI (<6, or 12 months) (8)(9)(10). However, studies on SCS for extra-pulmonary recurrences of uterine sarcomas are limited, and have only small sample sizes (4,11,(14)(15)(16)(17). Leitao et al (14) reported that optimal surgical resection may improve the survival of patients with either pulmonary or extra-pulmonary metastases, after retrospectively surveying 41 patients with recurrent LMS (including 28 patients who had non-thoracic recurrences).…”

“…Although 4 of these had multiple metastases (the number of metastases, 2-14), SCS may contribute to prolonged survival. Hoang et al (11) reported that single tumor recurrence was significantly correlated with a longer survival time, when compared with that of patients with >2 tumors. Based on the current examination, the resection of recurrent tumors may improve survival, even in patients with multiple extra-pulmonary diseases derived from uterine sarcomas.…”

“…Conversely, the management strategy for patients with recurrent uterine sarcomas has not been well established. The efficacy of resection for lung metastasis of uterine malignancies has been demonstrated in prior studies (8)(9)(10)(11); nevertheless, no consensus has been reached regarding the optimal treatment strategy at the time of relapse due to their rarity. The objective of the present study was to evaluate the efficacy of secondary cytoreductive surgery (SCS) for the treatment of recurrent uterine sarcomas.…”