Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes

Abstract

Objective In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP). Methods A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed. Results Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349–24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded. Conclusions Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.

Oncologic and Reproductive Outcomes of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: A Single Center Retrospective Study of 67 Cases

“…According to the limited statistics, STUMP is generally found in younger aged women than other tumors of the uterus. In this study, the median age of patients was 42 years, similar to previously reported cases (6)(7)(8)(9)(10)(11)(12). Since the patients are young, preserving fertility is an essential consideration in the selection of treatment.…”

“…The third important message is the pathological forecast for recurrences. It has previously been reported that the recurrence rate of STUMP ranged from 0 to 36.4%, and median interval time from initial treatment to recurrence was 51 months, ranging from 15 to 9 years (6)(7)(8)12). Molecular studies of SMT and leiomyosarcoma have identified the potential expressed proteins associated with poor prognosis in STUMP (16).…”

Recurrent Uterine Smooth-Muscle Tumors of Uncertain Malignant Potential (STUMP): State of The Art

“…In the case of myomectomy, close surveillance should be mandatory (37). Patients should also be aware of the realistic impact of fertility-sparing approaches; a recent study highlights the feasibility of these techniques despite the not insignificant risk of recurrence (38).…”

Clinical and reproductive outcomes of uterine smooth muscle tumor of uncertain malignant potential: a single-center retrospective study

“…6,21,23 There were no remarkable differences in recurrence rates between patients treated with myomectomy and hysterectomy. 12,17,[24][25][26][27][28] In the present study, six patients with STUMP underwent myomectomy and none experienced recurrence. Both patients with fertility requirements subsequently delivered full-term live babies.…”