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Outcome and prognostic factors in 110 consecutive patients with primary uterine leiomyosarcoma:A Rare Cancer Network study

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Chinese Journal of Cancer Research 2017年第6期29卷 521-532页

作者： Alessandra Franzetti Pellanda Berardino De Bari Elisabeth Deniaud-Alexandre MarcoKrengli paul van houtte Antonella Riehetti Salvador Villa Hadassah Goldberg EwaSzutowiez-Zielifiska Michel Bolla Heidi Rutten Marc van Eijkeren Philip Poortmans Guido Henke Yavuz Anaeak Steve Chan Christine Landmann Carine Kirkove LueianoScandolaro Jacques Bernier Rene-Olivier Mirimanof Mahmut Ozsahin Centre Hospitalier Universitaire Vaudois(CHUV) 1011 LausanneSwitzerland Clinica Luganese Moncucco 6903 LuganoSwitzerland Centre Hospitalier R6gional Universitaire"Jean Minjoz" INSERMUMR109825030 BesangonFrance Hopital Tenon 75970 ParisFrance Centre Hospitalier Departemental 85925 VendeeFrance degli Studi del Piemonte Orientale e Ospedale Maggiore della Carifi 28100 NovaraItaly University Institut Jules Bordet 1000 BrusselsBelgium 8Ospedale di Circolo 21100 VareseItaly Ospedale di Circolo 21100 VareseItalyt Istituto Oncologico della Svizzera Italiana EOC6500 BellinzonaSwitzerland Catalan Institute of Oncology Universitat Autbnoma de Barcelona08916 Barcelona 08916Spain Rambam Medical Center 31096 HaifaIsrael Medical University 80210 GdanskPoland Hopital Michallon BP21738043Grenoble cedex 09France Radboud University Medical Center 6525 NijmegenThe Netherlands Ghent University Hospital 9000 GentBelgium Institute Verbeeten 90120 TilburgThe Netherlands Kantonsspital St.Gallen 9007St.GallenSwitzerland Karadeniz Technical University 61080 TrabzonTurkey Nottingham University Hospital NHS trustNG5 1PB NottinghamUnited Kingdom Kantonsspital Basel 4031 BaselSwitzerland UCL St.Luc 1200 BrusselsBelgium presidio Ospedaliero Sant'Anna 22100 ComoItaly Ospedale San Giovanni 6500 BellinzonaSwitzerland Clinique de Genolier Genolier1272 Switzerland Department of Radiation Oncology Centre Hospitalier Universitaire Vaudois(CHUV)University of LausanneSwitzerland

Objective： Primary uterine leiomyosarcomas （ULMS） are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary ULMS. Methods： We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network （RCN）. Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS, aged 18-80 years, complete International Federation of Gynecology and Obstetrics （FIGO） stage information, complete information on treatment, and a minimum follow-up of 6 months. Local control （LC） and locoregional control （LRC）, overall survival （OS） and disease-free survival （DFS） rates were computed using the Kaplan-Meier method. Univariate analysis was implemented using the log rank test, and multivariate analysis using the Cox model. Results： All patients underwent surgery. Seventy-five patients （68%） received adjuvant radiotherapy （RT）, including brachytherapy in 18 （I 6%）. Seventeen patients （15 %） received adjuvant chemotherapy. Median follow-up was 58 （range, 6-240） months. Five-year OS and DFS rates were 50% and 34%, and LC and LRC rates were 88% and 72%, respectively. On multivariate analysis, independent favorable prognostic factors were younger age, FIGO stage I, small tumor size, previous uterine disease, and no vascular invasion for OS and DFS. FIGO stage was the only favorable factor influencing LRC. Adjuvant local or systemic treatments did not improve the outcomes. Eight patients treated with RT presented a grade 3 acute toxicity, and only one patient with grade 3 late toxicity. Conclusions： In this large population of primary ULMS patients, we found good results in terms of LC and LRC. Nevertheless, OS remains poor, mainly due to the occurrence of distant metastases. An early diagnosis seemed to improve the prognosis of the patients. Adjuvant local or systemic treatments, or more aggressive surgical procedures such as the Wertheim p

关键词： Uterine leiomyosarcoma prognostic factors radiotherapy overall survival local control

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