Kazuhiro Takehara1, Natsumi Yamashita2, Reiko Watanabe3, Norihiro Teramoto4, Hitoshi Tsuda5, Takashi Motohashi6, Kenichi Harano7, Toru Nakanishi8, Hideki Tokunaga9, Nobuyuki Susumu10, Yutaka Ueda11, Yoshihito Yokoyama12, Toshiaki Saito13. 1. Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemotomachi, Matsuyama, Japan. Electronic address: takehara.kazuhiro.ef@mail.hosp.go.jp. 2. Department of Clinical Research Center, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemotomachi, Matsuyama, Japan. Electronic address: yamashita.natsumi.zm@mail.hosp.go.jp. 3. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Japan. Electronic address: watanabe0153@yahoo.co.jp. 4. Department of Pathology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemotomachi, Matsuyama, Japan. Electronic address: teramoto.norihiro.zh@mail.hosp.go.jp. 5. Department of Basic Pathology, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Japan. Electronic address: htsuda@ndmc.ac.jp. 6. Department of Obstetrics and Gynecology, Tokyo Women's Medical University Hospital, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan. Electronic address: sr21det@rb3.so-net.ne.jp. 7. Department of Experimental Therapeutics/Breast Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Japan. Electronic address: kharano@east.ncc.go.jp. 8. Department of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aoba-ku, Sendai, Japan. Electronic address: trnakans@yahoo.co.jp. 9. Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho Aoba-ku, Sendai, Japan. Electronic address: tokunagahideki@med.tohoku.ac.jp. 10. Department of Obstetrics and Gynecology, International University of Health and Welfare, 4-3, Kozunomori, Narita, Japan. Electronic address: susumu35@iuhw.ac.jp. 11. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan. Electronic address: y.ueda@gyne.med.osaka-u.ac.jp. 12. Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 53 Honcho, Hirosaki, Japan. Electronic address: yokoyama@hirosaki-u.ac.jp. 13. Department of Gynecology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Nodame Minami-ku, Fukuoka, Japan. Electronic address: saito.toshiaki.hf@mail.hosp.go.jp.
Abstract
OBJECTIVE: Uterine leiomyosarcoma (uLMS) is a rare gynecologic malignancy for which the currently available treatments do not consistently provide long-term disease control. This study aimed to reveal the current clinical status of uLMS to support future clinical trials. METHODS: This study enrolled patients with uLMS treated at 53 Japanese institutions from 2000 to 2012. Central pathological review (CPR) was performed. All cases were confirmed by CPR, and epidemiological features, treatment, and prognosis were analyzed statistically. RESULTS: A total of 307 patients were enrolled. A diagnosis of uLMS was confirmed in 266 patients (86.6%) of patients after CPR, of whom data for 259 were analyzed. Of these, 186 (71.8%) patients underwent complete gross resection as primary therapy. Ninety-eight patients received no additional adjuvant therapy, while docetaxel and gemcitabine was the most frequent regimen among 155 patients treated with adjuvant chemotherapy. In all cases, the median overall survival (OS) was 44.2 months. Multivariate analyses of prognostic factors in all cases identified stage III and IV disease, high serum lactate dehydrogenase level, and menopausal status as poor prognostic factors. However, in stage I cases, high serum lactate dehydrogenase level and no adjuvant treatment were identified as poor prognostic factors. The 5-year OS of patients with stage I uLMS treated with adjuvant chemotherapy was significantly better than that of those without adjuvant treatment (67.8% vs 46.7%, P = 0.0461). CONCLUSIONS: Despite complete removal of the primary lesion, the clinical course of patients with uLMS was poor due to recurrence of distant metastasis. The application of a suitable biomarker and effective adjuvant chemotherapy are required to improve the prognosis of patients with uLMS.
OBJECTIVE:Uterine leiomyosarcoma (uLMS) is a rare gynecologic malignancy for which the currently available treatments do not consistently provide long-term disease control. This study aimed to reveal the current clinical status of uLMS to support future clinical trials. METHODS: This study enrolled patients with uLMS treated at 53 Japanese institutions from 2000 to 2012. Central pathological review (CPR) was performed. All cases were confirmed by CPR, and epidemiological features, treatment, and prognosis were analyzed statistically. RESULTS: A total of 307 patients were enrolled. A diagnosis of uLMS was confirmed in 266 patients (86.6%) of patients after CPR, of whom data for 259 were analyzed. Of these, 186 (71.8%) patients underwent complete gross resection as primary therapy. Ninety-eight patients received no additional adjuvant therapy, while docetaxel and gemcitabine was the most frequent regimen among 155 patients treated with adjuvant chemotherapy. In all cases, the median overall survival (OS) was 44.2 months. Multivariate analyses of prognostic factors in all cases identified stage III and IV disease, high serum lactate dehydrogenase level, and menopausal status as poor prognostic factors. However, in stage I cases, high serum lactate dehydrogenase level and no adjuvant treatment were identified as poor prognostic factors. The 5-year OS of patients with stage I uLMS treated with adjuvant chemotherapy was significantly better than that of those without adjuvant treatment (67.8% vs 46.7%, P = 0.0461). CONCLUSIONS: Despite complete removal of the primary lesion, the clinical course of patients with uLMS was poor due to recurrence of distant metastasis. The application of a suitable biomarker and effective adjuvant chemotherapy are required to improve the prognosis of patients with uLMS.