Surgical management and prognostic indicators of uterine leiomyosarcoma

Abstract

16024 Background: Uterine leiomyosarcoma (LMS) is a rare malignant tumor. Preoperative diagnosis is established only in 13.5% patients at our center. Currently, the main method of treatment of LMS is surgery. The efficacy of chemotherapy and radiotherapy are questionable. So, the aim of our study is to establish the optimal treatment modalities and prognostic indicators for this tumor. Methods: A retrospective chart review was done to 163 patients with LMS treated at the NNBRCRC from 1970 to 2002. Multivariate statistical analysis was performed to determine the most important prognostic indicators for LMS. Surgical treatment, as independent method, was performed to 108 patients (66.3 %). Combined treatment, including surgery and postoperative chemotherapy was performed to 30 patients (18.4 %), surgery + radiotherapy - 12 (7.4 %) patients. Complex treatment (surgery + chemotherapy + radiotherapy) was performed to 11 (6.7 %) patients. Results: Histologically, LMS is the most common (41,4%) among all sarcomas of female genital tract. Immunohistochemistry and electronmicroscopy play a major role in establishing the diagnosis. 5 year overall and disease - free survival of patients with LMS is 48.5± 4.2% and 44.3 ± 4.3 %, respectively. We observed association between ovarian preservation and improved survival: overall 5 year survival in patients with ovarian preservation and those who underwent oophorectomy is 87.3 ± 8.4 % and 49.0 ± 5.3 %, respectively (p<0,05). On the basis of multivariate analysis we determined the following prognostic indicators, affecting the outcome of patients with LMS: disease stage, mitotic index, tumor cell necrosis, depth of tumor invasion in myometrium, tumor size, age, menstrual status of the patients and optimal surgery. Conclusions: According to our data, the optimal surgery for LMS is total abdominal hysterectomy in the reproductive age and total abdominal hysterectomy with bilateral salpingo-oophorectomy in the postmenopausal period. The most favorable prognostic indicators are: patient age younger than 30, I stage of disease, tumor size less than 10 cm, less than 10 mitotic figures per 10 high - power fields, submucosal or subserosal location of well-differentiated tumor. No significant financial relationships to disclose.