BACKGROUND: Cancer staging systems aim to identify patient cohorts with different outcomes based on clinically relevant prognostic factors. Uterine leiomyosarcoma (ULMS) is classified using the FIGO staging system developed for epithelial malignancies; other sarcomas use the AJCC staging system. Neither has been validated in ULMS. We critically evaluated both systems to determine if either identified patient groups with distinct outcomes. METHODS: We staged 230 ULMS patients by the FIGO and AJCC systems. Progression-free survival (PFS) and overall survival (OS) rates were calculated; statistical pairwise comparisons were performed. RESULTS: The number of stages I and III patients varied by staging system. There were few stage II patients by either system. Using the FIGO system, PFS was better in stage I patients versus stage III or IV patients, and OS was better in stage I patients versus stage IV patients. Using the AJCC system, PFS and OS were better in stage I patients (low grade) versus stage II, III or IV patients, and OS was better in stage III patients versus stage IV patients. Prognosis of patients with serosal involvement (FIGO III) was similar to that of patients with metastases (FIGO IV). CONCLUSION: Neither system classifies ULMS patients into four clinically meaningful, non-overlapping stages predictive of PFS and OS. This analysis highlights the relevance of certain factors (low grade, serosal involvement) and rarity of others (FIGO stage II, cervical invasion). Once identified, prognostic factors relevant to this malignancy should be incorporated into a new staging system in an effort to identify appropriate cohorts for different treatments.
BACKGROUND: Cancer staging systems aim to identify patient cohorts with different outcomes based on clinically relevant prognostic factors. Uterine leiomyosarcoma (ULMS) is classified using the FIGO staging system developed for epithelial malignancies; other sarcomas use the AJCC staging system. Neither has been validated in ULMS. We critically evaluated both systems to determine if either identified patient groups with distinct outcomes. METHODS: We staged 230 ULMS patients by the FIGO and AJCC systems. Progression-free survival (PFS) and overall survival (OS) rates were calculated; statistical pairwise comparisons were performed. RESULTS: The number of stages I and III patients varied by staging system. There were few stage II patients by either system. Using the FIGO system, PFS was better in stage I patients versus stage III or IV patients, and OS was better in stage I patients versus stage IV patients. Using the AJCC system, PFS and OS were better in stage I patients (low grade) versus stage II, III or IV patients, and OS was better in stage III patients versus stage IV patients. Prognosis of patients with serosal involvement (FIGO III) was similar to that of patients with metastases (FIGO IV). CONCLUSION: Neither system classifies ULMS patients into four clinically meaningful, non-overlapping stages predictive of PFS and OS. This analysis highlights the relevance of certain factors (low grade, serosal involvement) and rarity of others (FIGO stage II, cervical invasion). Once identified, prognostic factors relevant to this malignancy should be incorporated into a new staging system in an effort to identify appropriate cohorts for different treatments.
Authors: Oliver Zivanovic; Lindsay M Jacks; Alexia Iasonos; Mario M Leitao; Robert A Soslow; Emanuela Veras; Dennis S Chi; Nadeem R Abu-Rustum; Richard R Barakat; Murray F Brennan; Martee L Hensley Journal: Cancer Date: 2011-07-12 Impact factor: 6.860
Authors: Eytan Ben-Ami; Constance M Barysauskas; Sarah Solomon; Kadija Tahlil; Rita Malley; Melissa Hohos; Kathleen Polson; Margaret Loucks; Mariano Severgnini; Tara Patel; Amy Cunningham; Scott J Rodig; F Stephen Hodi; Jeffrey A Morgan; Priscilla Merriam; Andrew J Wagner; Geoffrey I Shapiro; Suzanne George Journal: Cancer Date: 2017-04-25 Impact factor: 6.860
Authors: Sarah E Rutstein; Matthew T Siedhoff; Elizabeth J Geller; Kemi M Doll; Jennifer M Wu; Daniel L Clarke-Pearson; Stephanie B Wheeler Journal: J Minim Invasive Gynecol Date: 2015-10-22 Impact factor: 4.137
Authors: David B Chapel; Aarti Sharma; Ricardo R Lastra; Livia Maccio; Emma Bragantini; Gian Franco Zannoni; Suzanne George; Bradley J Quade; Carlos Parra-Herran; Marisa R Nucci Journal: Mod Pathol Date: 2022-02-04 Impact factor: 7.842