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Sun J, Jiao X, Wu Z, Yao T, Tuo S, Wang Y, Chen R, He J, Qian J, Xu S, Liu Q. Intraperitoneal spread in uterine sarcoma following unprotected laparoscopic transvaginal uterine morcellation: a case report and literature review. Front Oncol 2024; 14:1434720. [PMID: 39188684 PMCID: PMC11345641 DOI: 10.3389/fonc.2024.1434720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
Clinically and through auxiliary examinations, distinguishing uterine leiomyoma from early-stage uterine sarcoma presents significant challenges. A 48-year-old patient underwent a laparoscopic hysterectomy for uterine leiomyoma, during which a large uterus was excised through the vagina and extracted. Four months post-operation, the patient developed abdominal distension, indicative of extensive pelvic-abdominal dissemination of uterine sarcoma. We hypothesize that unprotected fibroid fragmentation increases the risk of uterine sarcoma spread, thereby worsening the prognosis. Our literature review aims to thoroughly understand the risks associated with unprotected transvaginal laparoscopic tumor division.
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Affiliation(s)
- Jianhao Sun
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xinjuan Jiao
- Qingyang Second People’s Hospital, Qingyang, Gansu, China
| | - Zhenzhen Wu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Tingting Yao
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Shumei Tuo
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yueyuan Wang
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Ruirong Chen
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Jing He
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Jifang Qian
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Shengfang Xu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Qing Liu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
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Abouelkhair MB, Shakweer MM, Faisal MM, Nasreldin MH, Farid LM. Diagnostic Value of Combined BCOR, Cyclin D1, and CD10 in Differentiating Endometrial Stromal Sarcoma From Other Uterine Spindle Cell Lesions. Appl Immunohistochem Mol Morphol 2024; 32:326-335. [PMID: 38961542 DOI: 10.1097/pai.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
Uterine spindle cell lesions share a dilemmatic overlapped features that needed to be addressed by the pathologist to reach a conclusive accurate diagnosis for its prognostic value and different management decisions. Usage of combined IHC panel can be an aiding guiding tool in this context. The aim of this study is to evaluate the diagnostic value of combined BCOR, Cyclin D1, and CD10 IHC panel in differentiating endometrial stromal sarcoma from other uterine spindle cell lesions. This study included 60 cases categorized into endometrial stromal sarcoma group (ESS) (12 cases high-grade endometrial stromal sarcoma [HGESS] and 18 cases low-grade endometrial stromal sarcoma [LGESS]), malignant uterine spindle cell lesions group (5 cases adenosarcoma [AS], 6 cases leiomyosarcoma [LS], 4 cases carcinosarcoma [CS]), and benign uterine lesions group (5 cases endometrial stromal nodule [ESN], 5 cases leiomyoma, and 5 cases adenomyosis). IHC staining procedure and evaluation for BCOR, Cyclin D1, and CD10 was performed on all studied cases. BCOR IHC staining was positive in all HGESS (12/12) of ESS group cases, with diffuse pattern in 75% of cases. BCOR-diffuse staining pattern was not recorded in any of LGESS (0/18), malignant mesenchymal lesions group (0/15), and also benign lesions group (0/15). Cyclin D1 positivity was observed only in HGESS cases, in parallel with positive-BCOR expression. On the contrary, CD10 was negatively expressed in all HGESS and positive in all LGESS, ESN, and adenomyosis cases. A specificity of 100% and sensitivity of 75% were recorded in differentiating HGESS from malignant mesenchymal lesions (including LMS, AS, and CS) and also HGESS from LGESS when using the combined panel BCOR +ve D /Cyclin D1 +ve / CD10 -ve , considering only the BCOR-diffuse staining pattern. In conclusion, BCOR +ve D /Cyclin D1 +ve /CD10 -ve as a combined panel is 100% specific and with lesser sensitivity in diagnosing HGESS as well as differentiating it from LGESS and other malignant uterine spindle cell lesions.
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Affiliation(s)
| | - Marwa M Shakweer
- Department of Pathology, Ain Shams University
- Department of Pathology, School of Medicine, Badr University in Cairo (BUC)
| | | | - Magda H Nasreldin
- Department of Pathology, ECDU Maternity Hospital, Ain Shams University, Cairo, Egypt
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Ciccarone F, Biscione A, Robba E, Pasciuto T, Giannarelli D, Gui B, Manfredi R, Ferrandina G, Romualdi D, Moro F, Zannoni GF, Lorusso D, Scambia G, Testa AC. A clinical ultrasound algorithm to identify uterine sarcoma and smooth muscle tumors of uncertain malignant potential in patients with myometrial lesions: the MYometrial Lesion UltrasouNd And mRi study. Am J Obstet Gynecol 2024:S0002-9378(24)00786-5. [PMID: 39084498 DOI: 10.1016/j.ajog.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Differential diagnosis between benign uterine smooth muscle tumors and malignant counterpart is challenging. OBJECTIVE To evaluate the accuracy of a clinical and ultrasound based algorithm in predicting mesenchymal uterine malignancies, including smooth muscle tumors of uncertain malignant potential. STUDY DESIGN We report the 12-month follow-up of an observational, prospective, single-center study that included women with at least 1 myometrial lesion ≥3 cm on ultrasound examination. These patients were classified according to a 3-class diagnostic algorithm, using symptoms and ultrasound features. "White" patients underwent annual telephone follow-up for 2 years, "Green" patients underwent a clinical and ultrasound follow-up at 6, 12, and 24 months and "Orange" patients underwent surgery. We further developed a risk class system to stratify the malignancy risk. RESULTS Two thousand two hundred sixty-eight women were included and target lesion was classified as benign in 2158 (95.1%), as other malignancies in 58 (2.6%) an as mesenchymal uterine malignancies in 52 (2.3%) patients. At multivariable analysis, age (odds ratio 1.05 [95% confidence interval 1.03-1.07]), tumor diameter >8 cm (odds ratio 5.92 [95% confidence interval 2.87-12.24]), irregular margins (odds ratio 2.34 [95% confidence interval 1.09-4.98]), color score=4 (odds ratio 2.73 [95% confidence interval 1.28-5.82]), were identified as independent risk factors for malignancies, whereas acoustic shadow resulted in an independent protective factor (odds ratio 0.39 [95% confidence interval 0.19-0.82[). The model, which included age as a continuous variable and lesion diameter as a dichotomized variable (cut-off 81 mm), provided the best area under the curve (0.87 [95% confidence interval 0.82-0.91]). A risk class system was developed, and patients were classified as low-risk (predictive model value <0.39%: 0/606 malignancies, risk 0%), intermediate risk (predictive model value 0.40%-2.2%: 9/1093 malignancies, risk 0.8%), high risk (predictive model value ≥2.3%: 43/566 malignancies, risk 7.6%). CONCLUSION The preoperative 3-class diagnostic algorithm and risk class system can stratify women according to risk of malignancy. Our findings, if confirmed in a multicenter study, will permit differentiation between benign and mesenchymal uterine malignancies allowing a personalized clinical approach.
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Affiliation(s)
- Francesca Ciccarone
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.
| | - Antonella Biscione
- Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Eleonora Robba
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Tina Pasciuto
- Data Collection G-STeP Research Core Facility, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics Facility, G-STeP Generator, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Benedetta Gui
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy; Catholic University of the Sacred Hearth, Rome, Italy
| | - Riccardo Manfredi
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy; Catholic University of the Sacred Hearth, Rome, Italy; University Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daniela Romualdi
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Francesca Moro
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Gian Franco Zannoni
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Pathology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonia Carla Testa
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy; Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
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Sen A. FIGO 2009 classification for uterine sarcoma staging: FIGO 2023 endometrial cancer classification for carcinosarcoma staging. Int J Gynaecol Obstet 2024. [PMID: 39016324 DOI: 10.1002/ijgo.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Anitha Sen
- Radiodiagnosis, Regional Cancer Centre, Thiruvananthapuram, India
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Wang JF, Li C, Yang JY, Wang YL, Ji J. Clinicopathological characteristics and prognosis of uterine sarcoma: a 10-year retrospective single-center study in China. Diagn Pathol 2024; 19:94. [PMID: 38970112 PMCID: PMC11225383 DOI: 10.1186/s13000-024-01517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Uterine sarcoma is a rare and heterogeneous gynecological malignancy characterized by aggressive progression and poor prognosis. The current study aimed to investigate the relationship between clinicopathological characteristics and the prognosis of uterine sarcoma in Chinese patients. METHODS In this single-center retrospective study, we reviewed the medical records of 75 patients with histologically verified uterine sarcoma treated at the First Affiliated Hospital of Xi'an Jiaotong University between 2011 and 2020. Information on clinical characteristics, treatments, pathology and survival was collected. Progression-free survival (PFS) and overall survival (OS) were visualized in Kaplan-Meier curves. Prognostic factors were identified using the log-rank test for univariate analysis and Cox-proportional hazards regression models for multivariate analysis. RESULTS The histopathological types included 36 endometrial stromal sarcomas (ESS,48%), 33 leiomyosarcomas (LMS,44%) and 6 adenosarcomas (8%). The mean age at diagnosis was 50.2 ± 10.7 years. Stage I and low-grade accounted for the majority. There were 26 recurrences and 25 deaths at the last follow-up. The mean PFS and OS were 89.41 (95% CI: 76.07-102.75) and 94.03 (95% CI: 81.67-106.38) months, respectively. Univariate analysis showed that > 50 years, post-menopause, advanced stage, ≥ 1/2 myometrial invasion, lymphovascular space invasion and high grade were associated with shorter survival (P < 0.05). Color Doppler flow imaging positive signals were associated with shorter PFS in the LMS group (P = 0.046). The ESS group had longer PFS than that of the LMS group (99.56 vs. 76.05 months, P = 0.043). The multivariate analysis showed that post-menopause and advanced stage were independent risk factors of both PFS and OS in the total cohort and LMS group. In the ESS group, diagnosis age > 50 years and high-grade were independent risk factors of PFS, while high-grade and lymphovascular space invasion were independent risk factors of OS. CONCLUSION In Chinese patients with uterine sarcoma, post-menopause and advanced stage were associated with a significantly poorer prognosis. The prognosis of ESS was better than that of LMS. Color Doppler flow imaging positive signals of the tumor helped to identify LMS, which needs to be further tested in a larger sample in the future.
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Affiliation(s)
- Jin-Feng Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Chen Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Jing-Yi Yang
- Medical Records Room, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Yue-Ling Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Jing Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
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Lewis D, Liang A, Mason T, Ferriss JS. Current Treatment Options: Uterine Sarcoma. Curr Treat Options Oncol 2024; 25:829-853. [PMID: 38819624 DOI: 10.1007/s11864-024-01214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
OPINION STATEMENT The cornerstone of treatment for uterine sarcoma, regardless of histologic type, remains en bloc surgical resection with total hysterectomy. In the case of incidental diagnosis during another procedure, such as myomectomy, where a hysterectomy was not performed initially, completion hysterectomy or cervical remnant removal is recommended. The completion of additional surgical procedures, including bilateral salpingo-oophorectomy and lymphadenectomy, remains nuanced. Bilateral salpingo-oophorectomy remains controversial in the setting of most subtypes of uterine sarcoma, except in the case of hormone-receptor positivity, such as in low grade endometrial stromal sarcoma, where it is indicated as part of definitive surgical treatment. In the absence of apparent nodal involvement, we do not recommend performing universal lymphadenectomy for patients with sarcoma. We recommend systemic therapy for patients with extra-uterine or advanced stage disease, high-grade histology, and recurrence. The most active chemotherapy regimens for advanced, high-grade disease remain doxorubicin or gemcitabine and docetaxol combination therapy. A notable exception is low grade endometrial stromal sarcoma, where we recommend anti-hormonal therapy in the front-line setting. Radiation therapy is reserved for selected cases where it can aid in palliating symptoms.
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Affiliation(s)
- Dana Lewis
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Angela Liang
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Terri Mason
- Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Stuart Ferriss
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Yang Q, Madueke-Laveaux OS, Cun H, Wlodarczyk M, Garcia N, Carvalho KC, Al-Hendy A. Comprehensive Review of Uterine Leiomyosarcoma: Pathogenesis, Diagnosis, Prognosis, and Targeted Therapy. Cells 2024; 13:1106. [PMID: 38994959 PMCID: PMC11240800 DOI: 10.3390/cells13131106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
Uterine leiomyosarcoma (uLMS) is the most common subtype of uterine sarcomas. They have a poor prognosis with high rates of recurrence and metastasis. The five-year survival for uLMS patients is between 25 and 76%, with survival rates approaching 10-15% for patients with metastatic disease at the initial diagnosis. Accumulating evidence suggests that several biological pathways are involved in uLMS pathogenesis. Notably, drugs that block abnormal functions of these pathways remarkably improve survival in uLMS patients. However, due to chemotherapy resistance, there remains a need for novel drugs that can target these pathways effectively. In this review article, we provide an overview of the recent progress in ascertaining the biological functions and regulatory mechanisms in uLMS from the perspective of aberrant biological pathways, including DNA repair, immune checkpoint blockade, protein kinase and intracellular signaling pathways, and the hedgehog pathway. We review the emerging role of epigenetics and epitranscriptome in the pathogenesis of uLMS. In addition, we discuss serum markers, artificial intelligence (AI) combined with machine learning, shear wave elastography, current management and medical treatment options, and ongoing clinical trials for patients with uLMS. Comprehensive, integrated, and deeper insights into the pathobiology and underlying molecular mechanisms of uLMS will help develop novel strategies to treat patients with this aggressive tumor.
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Affiliation(s)
- Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | | | - Han Cun
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Marta Wlodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Natalia Garcia
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Department of Cell Systems and Anatomy, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento deObstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
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8
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De Bruyn C, Ceusters J, Vanden Brande K, Timmerman S, Froyman W, Timmerman D, Van Rompuy AS, Coosemans A, Van den Bosch T. Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:683-690. [PMID: 37970762 DOI: 10.1002/uog.27535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Timely and accurate preoperative diagnosis of uterine sarcoma will increase patient survival. The primary aim of this study was to describe the ultrasound features of uterine sarcoma compared with those of uterine leiomyoma based on the terms and definitions of the Morphological Uterus Sonographic Assessment (MUSA) group. A secondary aim was to assess the interobserver agreement for reporting on ultrasound features according to MUSA terminology. METHODS This was a retrospective cohort study of patients with uterine sarcoma or uterine leiomyoma treated in a single tertiary center during the periods 1997-2019 and 2016-2019, respectively. Demographic characteristics, presenting symptoms and surgical outcomes were extracted from patients' files. Ultrasound images were re-evaluated independently by two sonologists using MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed using Cohen's κ (with squared weights) or intraclass correlation coefficient, as appropriate. RESULTS A total of 107 patients were included, of whom 16 had a uterine sarcoma and 91 had a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107 (64%)). Compared with leiomyoma cases, patients with uterine sarcoma were older (median age, 65 (interquartile range (IQR), 60-70) years vs 48 (IQR, 43-52) years) and more likely to be postmenopausal (13/16 (81%) vs 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%)), followed by adenosarcoma (4/16 (25%)). On ultrasound evaluation, according to Observers 1 and 2, the tumor border was irregular in most sarcomas (11/16 (69%) and 13/16 (81%) cases, respectively), but regular in most leiomyomas (65/91 (71%) and 82/91 (90%) cases, respectively). Lesion echogenicity was classified as non-uniform in 68/91 (75%) and 51/91 (56%) leiomyomas by Observers 1 and 2, respectively, and 15/16 (94%) uterine sarcomas by both observers. More than 60% of the uterine sarcomas showed acoustic shadows (11/16 (69%) and 10/16 (63%) cases by Observers 1 and 2, respectively), whereas calcifications were reported in a small minority (0/16 (0%) and 2/16 (13%) cases by Observers 1 and 2, respectively). In uterine sarcomas, intralesional vascularity was reported as moderate to abundant in 13/16 (81%) cases by Observer 1 and 15/16 (94%) cases by Observer 2, while circumferential vascularity was scored as moderate to abundant in 6/16 (38%) by both observers. Interobserver agreement for the presence of cystic areas, calcifications, acoustic shadow, central necrosis, color score (overall, intralesional and circumferential) and maximum diameter of the lesion was moderate. The agreement for shape of lesion, tumor border and echogenicity was fair. CONCLUSIONS A postmenopausal patient presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders, moderate-to-abundant intralesional vascularity, cystic areas and an absence of calcifications on ultrasonography is at a higher risk of having a uterine sarcoma. Interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the abovementioned clinical and ultrasound findings on uterine mesenchymal tumors in a prospective multicenter fashion. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C De Bruyn
- Department of Development and Regeneration Cluster Woman and Child, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
| | - J Ceusters
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, KU Leuven, Leuven, Belgium
| | - K Vanden Brande
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, KU Leuven, Leuven, Belgium
| | - S Timmerman
- Department of Development and Regeneration Cluster Woman and Child, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - W Froyman
- Department of Development and Regeneration Cluster Woman and Child, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Development and Regeneration Cluster Woman and Child, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - A-S Van Rompuy
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, University of Leuven, Leuven, Belgium
| | - A Coosemans
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, KU Leuven, Leuven, Belgium
| | - T Van den Bosch
- Department of Development and Regeneration Cluster Woman and Child, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
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9
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Denu RA, Dann AM, Keung EZ, Nakazawa MS, Nassif Haddad EF. The Future of Targeted Therapy for Leiomyosarcoma. Cancers (Basel) 2024; 16:938. [PMID: 38473300 PMCID: PMC10930698 DOI: 10.3390/cancers16050938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Leiomyosarcoma (LMS) is an aggressive subtype of soft tissue sarcoma that arises from smooth muscle cells, most commonly in the uterus and retroperitoneum. LMS is a heterogeneous disease with diverse clinical and molecular characteristics that have yet to be fully understood. Molecular profiling has uncovered possible targets amenable to treatment, though this has yet to translate into approved targeted therapies in LMS. This review will explore historic and recent findings from molecular profiling, highlight promising avenues of current investigation, and suggest possible future strategies to move toward the goal of molecularly matched treatment of LMS. We focus on targeting the DNA damage response, the macrophage-rich micro-environment, the PI3K/mTOR pathway, epigenetic regulators, and telomere biology.
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Affiliation(s)
- Ryan A. Denu
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Amanda M. Dann
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Michael S. Nakazawa
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elise F. Nassif Haddad
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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10
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Talia KL, Parra-Herran C, McCluggage WG. Macroscopic examination of gynaecological specimens: a critial and often underemphasised aspect of pathological reporting. J Clin Pathol 2024; 77:190-203. [PMID: 38373782 DOI: 10.1136/jcp-2023-208832] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024]
Abstract
Pathological examination of surgical specimens and compilation of a surgical pathology report comprises a series of events which includes macroscopic examination and tissue sampling, either complete or selected. This step is critical but often overlooked in the literature and not given the attention it deserves. In this review, we discuss the macroscopic examination and grossing of gynaecological pathology specimens, with reference to national and international protocols. We provide guidance as to the degree of sampling necessary in different scenarios and stress that a common-sense approach is necessary with flexibility in the degree of sampling depending on a variety of factors.
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Affiliation(s)
- Karen L Talia
- Department of Pathology, The Royal Children's Hospital and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
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11
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Song Y, Li R, Wang L, Wang H. Case Report: A Rare Case of Primary Angiosarcoma of the Cervix with a Literature Review. Int J Womens Health 2024; 16:265-271. [PMID: 38370343 PMCID: PMC10871135 DOI: 10.2147/ijwh.s439583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Primary angiosarcomas are a rare type of soft-tissue sarcomas that originate from endothelial cells. These sarcomas can develop in any part of the body and have a poor prognosis. However, they are commonly found in the skin of elderly white men, particularly on the scalp and head region. Primary angiosarcoma of the cervix is exceptionally rare. To date, only two cases of this disease have been reported worldwide. The diagnosis of the disease is difficult microscopically, requiring immunohistochemistry and genetic testing to distinguish. We report a recent case, in which the lesion was preoperatively considered a high-grade endometrial stromal sarcoma. A 35-year-old woman presented with vaginal bleeding and cervical erosions. A high-grade endometrial stromal sarcoma involving the cervix was considered and a modified radical hysterectomy was performed with bilateral salpingo-oophorectomy and sentinel lymph nodes resection. The gene diagnosis performed by fluorescence in situ hybridization for YWHAE translocation fusion was negative excluding a YWHAE-translocated high-grade endometrial stromal sarcoma. A primary angiosarcoma of the cervix was finally diagnosed. Primary angiosarcoma of the cervix is rare, and gynecologic pathologists do not know it well, so it is easy to be wrongly considered. Immunohistochemistry and genetic testing help confirm the diagnosis.
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Affiliation(s)
- Yuelin Song
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Ruizhe Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Lifei Wang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, People’s Republic of China
| | - Hongjing Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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12
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Istl AC, Desravines N, Nudotor R, Stone R, Greer JB, Meyer CF, Johnston FM. Treatment patterns and outcomes for primary uterine leiomyosarcoma with synchronous isolated lung metastases: A National Cancer Database study of primary resection and metastasectomy. Gynecol Oncol Rep 2024; 51:101308. [PMID: 38174328 PMCID: PMC10758710 DOI: 10.1016/j.gore.2023.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Background One third of patients with uterine leiomyosarcomas (uLMS) present with distant metastases. Current guidelines do not include recommendations around surgery for metastatic uLMS. Patients with distant metastases commonly receive primary tumor resection for symptoms and so oncologic outcomes after surgery warrant exploration. We describe treatment patterns and outcomes for uLMS patients with synchronous isolated lung metastases (SILM). Methods This retrospective analysis of the National Cancer Database identified patients with uLMS and SILM. Patients with non-pulmonary metastases were excluded. We collected demographic, disease, and treatment characteristics and assessed clinicopathologic factors associated with the receipt of surgery on multivariate regression. Median, 1-year, and 5-year overall survival (OS) across treatment approaches were compared using Kaplan-Meier curves and log-rank tests. Multivariate Cox proportional hazard regressions identified independent predictors of survival. Results We identified 905 patients with uLMS and SILM between 2004 and 2017. 600 patients had primary tumor resection; 63 also had curative intent surgery with metastasectomy. Patients who did not receive chemotherapy were older (p<0.01) with a higher comorbidity index (p<0.05). Women with private health insurance were more likely to receive chemotherapy (p<0.01) and primary tumor resection (p<0.01). Patients who underwent curative intent surgery had 1-year OS of 71.2% and 5-year survival of 18% compared to 1-year survival of 35.6 % and 5-year survival of 5.16 % for patients who had no surgery. Black women had poorer survival on multivariate regression. Conclusions Primary tumor resection and curative intent surgery are associated with improved OS in uLMS with SILM and may be a reasonable treatment option in appropriately selected patients.
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Affiliation(s)
- Alexandra C. Istl
- Division of Surgical Oncology, Medical College of Wisconsin, United States
| | | | - Richard Nudotor
- Department of Surgery, Anne Arundel Medical Center, United States
| | - Rebecca Stone
- Division of Gynecologic Oncology, Johns Hopkins Hospital, United States
| | - Jonathan B. Greer
- Division of Surgical Oncology, Johns Hopkins Hospital, United States
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13
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Bharathan R, Polterauer S, Lopez-Sanclemente MC, Trukhan H, Pletnev A, Heredia AG, Gil MM, Bakinovskaya I, Dalamanava A, Romeo M, Rovski D, Baquedano L, Chiva L, Schwameis R, Zapardiel I, On Behalf Of Sarcut Study Group. Prognostic Value of Lymph Node Ratio in Patients with Uterine Carcinosarcoma. J Pers Med 2024; 14:155. [PMID: 38392588 PMCID: PMC10890673 DOI: 10.3390/jpm14020155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/24/2024] Open
Abstract
Uterine carcinosarcoma is a rare high-grade endometrial cancer. Controversy has surrounded a number of aspects in the diagnosis and management of this unique clinicopathological entity, including the efficacy of adjuvant therapy, which has been questioned. An unusual surgico-pathological parameter with prognostic significance in a number of tumour sites is the lymph node ratio (LNR). The availability of data in this respect has been scarce in the literature. The primary aim of this collaborative study was to evaluate the prognostic value of LNR in patients with uterine carcinosarcoma. LNR is a recognized lymph node metric used to stratify prognosis in a variety of malignancies. In this European multinational retrospective study, 93 women with uterine carcinosarcoma were included in the final analysis. We used t-tests and ANOVA for comparison between quantitative variables between the groups, and chi-square tests for qualitative variables. A multivariate analysis using Cox regression analysis was performed to determine potential prognostic factors, including the LNR. Patients were grouped with respect to LNR in terms of 0%, 20% > 0% and >20%. The analysis revealed LNR to be a significant predictor of progression-free survival (HR 1.69, CI (1.12-2.55), p = 0.012) and overall survival (HR 1.71, CI (1.07-2.7), p = 0.024). However, LNR did not remain a significant prognostic factor on multivariate analysis. Due to limitations of the retrospective study, a prospective large multinational study, which takes into effect the most recent changes to clinical practice, is warranted to elucidate the value of the pathophysiological metrics of the lymphatic system associated with prognosis.
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Affiliation(s)
- Rasiah Bharathan
- Department of Obstetrics and Gynecology, Medical University Vienna, 1090 Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University Vienna, 1090 Vienna, Austria
| | | | - Hanna Trukhan
- N.N. Alexandrov National Cancer Center, 223040 Minsk, Belarus
| | - Andrei Pletnev
- N.N. Alexandrov National Cancer Center, 223040 Minsk, Belarus
| | - Angel G Heredia
- Clinica de Especialidades de la Mujer, Mexico City 03810, Mexico
| | - Maria M Gil
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
| | | | | | - Margarita Romeo
- Instituto Catalan de Oncologia Badalona, 08916 Barcelona, Spain
| | - Dzmitry Rovski
- N.N. Alexandrov National Cancer Center, 223040 Minsk, Belarus
| | | | - Luis Chiva
- Obstetrics and Gynecology Department, Clinica Universidad de Navarra, 28027 Madrid, Spain
| | - Richard Schwameis
- Department of Obstetrics and Gynecology, Medical University Vienna, 1090 Vienna, Austria
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
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14
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Du J, Hu D, Xing Y, He R, Cheng Y, Li H, Liu C, Liang X, Yang Y. Correlation between malignant peritoneal cytology and survival in patients with uterine leiomyosarcoma and endometrial stromal sarcoma. Int J Gynecol Cancer 2024; 34:58-65. [PMID: 37821125 DOI: 10.1136/ijgc-2023-004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE This study aimed to examine the correlation between malignant peritoneal cytology and overall survival among patients with uterine leiomyosarcoma and endometrial stromal sarcoma. METHODS Patients with uterine leiomyosarcoma and endometrial stromal sarcoma between January 2010 and December 2016 were identified from the Surveillance, Epidemiology, and End Results database. The multiple imputation method was used to address missing values. Propensity score matching was conducted to balance baseline data between the malignant and negative peritoneal cytology groups. The prognostic significance of malignant peritoneal cytology was evaluated using Cox regression, random survival forest, and subgroup analyses. RESULTS Among 733 eligible patients, 8% (59/733) had malignant peritoneal cytology, increasing to 20% (42/209) in advanced cases. Before and after propensity score matching, patients with malignant peritoneal cytology had significantly lower 5-year overall survival rates and shorter median survival time than patients with negative peritoneal cytology. Multivariate Cox regression revealed that malignant peritoneal cytology (hazard ratio 2.03, 95% confidence interval 1.29 to 3.20, p=0.002) was an independent prognostic factor for uterine leiomyosarcoma and endometrial stromal sarcoma. Random survival forest further indicated that, among the factors analyzed, peritoneal cytology status was second only to the International Federation of Gynecology and Obstetrics (FIGO) stage in terms of prognostic prediction. Finally, subgroup analyses substantiated the correlation between malignant peritoneal cytology and unfavorable overall survival in most subgroups. CONCLUSIONS Malignant peritoneal cytology status was an important prognostic factor complementing FIGO stage and was associated with a reduction in overall survival. Peritoneal cytology evaluation during hysterectomy may be recommended for prognosis estimation for uterine leiomyosarcoma and endometrial stromal sarcoma.
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Affiliation(s)
- Junhong Du
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Dan Hu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yijuan Xing
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Ruifen He
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yuemei Cheng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Hongli Li
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Chang Liu
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Liang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yongxiu Yang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
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15
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Kim H, Rha SE, Shin YR, Kim EH, Park SY, Lee SL, Lee A, Kim MR. Differentiating Uterine Sarcoma From Atypical Leiomyoma on Preoperative Magnetic Resonance Imaging Using Logistic Regression Classifier: Added Value of Diffusion-Weighted Imaging-Based Quantitative Parameters. Korean J Radiol 2024; 25:43-54. [PMID: 38184768 PMCID: PMC10788609 DOI: 10.3348/kjr.2023.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE To evaluate the added value of diffusion-weighted imaging (DWI)-based quantitative parameters to distinguish uterine sarcomas from atypical leiomyomas on preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 138 patients (age, 43.7 ± 10.3 years) with uterine sarcoma (n = 44) and atypical leiomyoma (n = 94) were retrospectively collected from four institutions. The cohort was randomly divided into training (84/138, 60.0%) and validation (54/138, 40.0%) sets. Two independent readers evaluated six qualitative MRI features and two DWI-based quantitative parameters for each index tumor. Multivariable logistic regression was used to identify the relevant qualitative MRI features. Diagnostic classifiers based on qualitative MRI features alone and in combination with DWI-based quantitative parameters were developed using a logistic regression algorithm. The diagnostic performance of the classifiers was evaluated using a cross-table analysis and calculation of the area under the receiver operating characteristic curve (AUC). RESULTS Mean apparent diffusion coefficient value of uterine sarcoma was lower than that of atypical leiomyoma (mean ± standard deviation, 0.94 ± 0.30 10-3 mm²/s vs. 1.23 ± 0.25 10-3 mm²/s; P < 0.001), and the relative contrast ratio was higher in the uterine sarcoma (8.16 ± 2.94 vs. 4.19 ± 2.66; P < 0.001). Selected qualitative MRI features included ill-defined margin (adjusted odds ratio [aOR], 17.9; 95% confidence interval [CI], 1.41-503, P = 0.040), intratumoral hemorrhage (aOR, 27.3; 95% CI, 3.74-596, P = 0.006), and absence of T2 dark area (aOR, 83.5; 95% CI, 12.4-1916, P < 0.001). The classifier that combined qualitative MRI features and DWI-based quantitative parameters showed significantly better performance than without DWI-based parameters in the validation set (AUC, 0.92 vs. 0.78; P < 0.001). CONCLUSION The addition of DWI-based quantitative parameters to qualitative MRI features improved the diagnostic performance of the logistic regression classifier in differentiating uterine sarcomas from atypical leiomyomas on preoperative MRI.
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Affiliation(s)
- Hokun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Eu Hyun Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Soo Youn Park
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Su-Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Ahwon Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Yang L, Cai Y, Wang Y, Huang Y, Zhang C, Ma H, Zhou JG. Fibroblast Growth Factor 23 is a Potential Prognostic Biomarker in Uterine Sarcoma. Technol Cancer Res Treat 2024; 23:15330338241245924. [PMID: 38613349 PMCID: PMC11015760 DOI: 10.1177/15330338241245924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Uterine sarcoma (US) is a highly malignant cancer with poor prognosis and high mortality in women. In this study, we evaluated the expression of human fibroblast growth factor 23 (FGF23) in different US subtypes and the relationship between survival and clinicopathological characteristics. METHODS We conducted a comparative analysis of FGF23 gene expression in different pathological types of US. Utilizing a cohort from The Cancer Genome Atlas of 57 patients, a 50-patient microarray dataset (GSE119043) from the Gene Expression Omnibus and a Suining cohort of 44 patients, we analyzed gene expression profiles and corresponding clinicopathological information. Immunohistochemistry was used to examine the expression level of FGF23 in four US subtypes. Survival analysis was used to assess the relationship between FGF23 expression and prognosis in US patients. RESULTS Compared with uterine normal smooth muscle and uterine leiomyoma, FGF23 expression was significantly upregulated in US and was differentially expressed in four US subtypes. Uterine carcinosarcoma exhibited the highest expression of FGF23 among the subtypes. Survival analysis revealed no correlation between FGF23 expression and either overall survival or progression-free survival in US (P > 0.05). Similar results were obtained from the validation cohorts. Univariate and multivariate analyses showed no significant correlation between FGF23 expression and the US prognosis. Tumor stage, CA125, and tumor recurrence were independent prognostic factors for survival of US patients. CONCLUSION FGF23 was highly expressed in US and was promising as a novel potential biomarker for the diagnosis and prognosis of US.
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Affiliation(s)
- Ling Yang
- Department of Pathology, Suining Central Hospital, Suining, China
| | - Ying Cai
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yunjia Wang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yue Huang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chi Zhang
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
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17
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Garcia N, Ulin M, Yang Q, Ali M, Bosland MC, Zeng W, Chen L, Al-Hendy A. Survivin-Sodium Iodide Symporter Reporter as a Non-Invasive Diagnostic Marker to Differentiate Uterine Leiomyosarcoma from Leiomyoma. Cells 2023; 12:2830. [PMID: 38132150 PMCID: PMC10741838 DOI: 10.3390/cells12242830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Leiomyosarcoma (LMS) has been challenging to diagnose because of limitations in clinical and radiographic predictors, as well as the lack of reliable serum or urinary biomarkers. Most uterine masses consist of benign leiomyoma (LM). However, it is currently a significant challenge in gynecology practice to differentiate LMS from LM. This inability poses grave consequences for patients, leading to a high number of unnecessary hysterectomies, infertility, and other major morbidities and possible mortalities. This study aimed to evaluate the use of Survivin-Sodium iodide symporter (Ad-Sur-NIS) as a reporter gene biomarker to differentiate malignant LMS from benign LM by using an F18-NaBF4 PET/CT scan. The PET/CT scan images showed a significantly increased radiotracer uptake and a decreased radiotracer decay attributable to the higher abundance of Ad-Sur-NIS in the LMS tumors compared to LM (p < 0.05). An excellent safety profile was observed, with no pathological or metabolic differences detected in Ad-Sur-NIS-treated animal versus the vehicle control. Ad-Sur-NIS as a PET scan reporter is a promising imaging biomarker that can differentiate uterine LMS from LM using F18-NaBF4 as a radiotracer. As a new diagnostic method, the F18 NaBF4 PET/CT scan can provide a much-needed tool in clinical practices to effectively triage women with suspicious uterine masses and avoid unnecessary invasive interventions.
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Affiliation(s)
- Natalia Garcia
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
- Greehey Children’s Cancer Research Institute, The University of Texas Health Science Center, San Antonio, TX 77030, USA
| | - Mara Ulin
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Chicago, IL 11537, USA
| | - Qiwei Yang
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Mohamed Ali
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt
| | - Maarten C. Bosland
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Weiqiao Zeng
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
| | - Liaohai Chen
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
| | - Ayman Al-Hendy
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA; (N.G.); (M.U.); (Q.Y.); (M.A.); (W.Z.); (L.C.)
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
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18
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Kannan M, Devarajan M, Vasudevan S. Case Series of Incidental Findings of Low-Grade Endometrial Stromal Sarcoma on Routine Hysterectomy for Uterine Fibroids. Cureus 2023; 15:e50676. [PMID: 38229799 PMCID: PMC10790155 DOI: 10.7759/cureus.50676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
This study is a retrospective review of data from patients who were incidentally diagnosed with endometrial stromal sarcoma after a routine hysterectomy for uterine fibroid at the Department of Gynaecologic Oncology in a tertiary care hospital. The Institutional Review Board (IRB) gave its clearance for this study before it was carried out. Informed written consent was obtained from all patients. In our case series, the three patients presented with complaints of menorrhagia, lower abdominal pain, intermenstrual bleeding, and acute retention of urine. After the patients underwent a clinical examination and radiological scan, the diagnosis of fibroids was made. They underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histology revealed low-grade endometrial stromal sarcoma (LGESS). The patients were observed for adjuvant therapy. The patients had a follow-up period of 18-24 months. In LGESS, which is rare, prompt management is of utmost importance, because the tumour's stage is the most significant predictor of the prognosis. As there are no clear indications to suggest the presence of LGESS prior to the histopathology of the specimen, it is necessary to analyze the data of patients who are diagnosed with LGESS, in order to investigate and manage the condition more appropriately. After myomectomy for a suspected leiomyoma, there is a 0.2% chance of the result showing endometrial stromal sarcoma.
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Affiliation(s)
- Mahalakshmi Kannan
- Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Mohanapriya Devarajan
- Obstetrics and Gynecology, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sudha Vasudevan
- Pathology and Laboratory Medicine, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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19
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Gracia M, Yildirim Y, Macuks R, Mancari R, Achimas-Cadariu P, Cusine-Lopez L, Novak Z, Dallaku K, Zapardiel I. Impact of perioperative characteristics on the recurrence risk and survival of patients with uterine leiomyosarcoma. Int J Gynaecol Obstet 2023; 163:868-874. [PMID: 37485666 DOI: 10.1002/ijgo.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To analyze the impact of perioperative characteristics on the risk of recurrence in patients with uterine leiomyosarcomas. METHODS A sub-analysis of the SARComa of the UTerus (SARCUT) study, which is a multicentric cross-sectional pan-European study that included 390 patients diagnosed with leiomyosarcoma, between 2001 and 2007. Perioperative factors related to risk of recurrence and survival were analyzed. RESULTS The 5-year and 10-year disease-free survivals (DFS) were 46% and 55%, respectively. Overall survival at 5 and 10 years was 34% and 47%, respectively. The most important factors related to global recurrence were the incomplete cytoreduction (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.91-4.31); performing bilateral adnexectomy (HR 2.71; 95% CI 1.23-5.93); tumor persistence after any treatment (HR 2.38; 95% CI 1.39-4.06); and adjuvant chemotherapy administration (HR 2.55; 95% CI 1.82-3.58) or adjuvant radiotherapy (HR 2.26; 95% CI 1.53-3.32). The major factors significantly associated with pelvic relapse were tumor persistence after any treatment (HR 3.63; 95% CI 1.83-7.20) and adjuvant radiotherapy (HR 2.74; 95% CI 1.44-5.20). Incomplete cytoreduction was the most important factor associated with distant relapse (HR 1.91; 95% CI 1.22-2.97). The most important factors related to overall survival were tumor persistence after any treatment (HR 4.59; 95% CI 2.51-8.40), incomplete cytoreduction (HR 3.68; 95% CI 2.44-5.56), tumor margin involvement (HR 2.41; 95% CI 1.64-3.55) and adjuvant chemotherapy (HR 1.91; 95% CI 1.31-2.78). CONCLUSIONS Complete cytoreduction is the main prognosis factor impacting the DFS and overall survival of patients with uterine leiomyosarcoma. Adjuvant chemotherapy administration was associated with decreased rates of DFS and overall survival. The adjuvant radiotherapy was associated with a higher risk of global recurrence.
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Affiliation(s)
- Myriam Gracia
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Ronalds Macuks
- Latvian Oncology Center of Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Rosanna Mancari
- Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Zoltan Novak
- Department of Gynecologic Oncology, National Institute of Oncology, Budapest, Hungary
| | - Kastriot Dallaku
- Obstetric Gynecology University Hospital Koco Gliozheni, Tirana, Albania
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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20
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Morcet-Delattre R, Espenel S, Tas P, Chargari C, Escande A. Role of radiotherapy in the management of rare gynaecological cancers. Cancer Radiother 2023; 27:778-788. [PMID: 37925347 DOI: 10.1016/j.canrad.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 11/06/2023]
Abstract
There are a large number of gynaecological cancers with rare histologies, for which the available data are limited and usually retrospective. Because of their rarity and poor prognosis, the management of these cancers must be centralized in expert centres, for both histological diagnosis and treatment. With the exception of sarcomas, most endometrial or cervical cancers with rare histologies respond to the same radiation treatment modalities than cancers with more common histologies, although there are some specificities regarding treatments such as neuroendocrine carcinomas (chemotherapy with platinum and etoposide, major role of surgery). For localized or locally advanced ovarian cancer, external beam radiotherapy has a role in the management of hypercalcaemic small cell carcinoma of the ovary. This article summarizes the current role of external beam radiotherapy and brachytherapy in the management of cancers of the uterine cervix, uterine corpus and ovaries, with rare or very rare histologies, and with localized or locally advanced stages.
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Affiliation(s)
- R Morcet-Delattre
- Radiation oncology department, centre Eugène-Marquis, Rennes, France.
| | - S Espenel
- Radiation oncology department, Gustave-Roussy Cancer Campus, Villejuif, France
| | - P Tas
- Anatomopathology department, Ouest pathologie, Rennes, France
| | - C Chargari
- Radiation oncology department, groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - A Escande
- Radiation oncology department, centre Léonard-de-Vinci, Dechy, France; Laboratoire CRIStAL UMR9189, université de Lille, CNRS, Lille, France
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21
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Zhu M, Chen S. Clinical features of uterine sarcomas presenting mainly with uterine masses: a retrospective study. BMC Womens Health 2023; 23:394. [PMID: 37496042 PMCID: PMC10373283 DOI: 10.1186/s12905-023-02517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Uterine sarcomas are uncommon mesenchymal tumors of the uterus. The clinical problem is that the features of uterine sarcomas can sometimes mimic uterine fibroids. This study aims to investigate the clinical characteristics of patients with uterine sarcomas who were preoperative presenting mainly with uterine masses. METHODS A retrospective analysis of patients who underwent gynecological surgery for uterine sarcomas at the Obstetrics & Gynecology Hospital of Fudan University, between January 2016 and December 2021. RESULTS Over the 5-year period, 277 patients were final diagnosed of uterine sarcomas. A total of 162 patients were preoperatively diagnosed as uterine fibroids for surgical treatment, the majority of whom were diagnosed of uterine leiomyosarcoma (uLMS) (49/162) and low-grade endometrial stromal sarcoma (LG-ESS) (100/162). Ninety people underwent total hysterectomy and bilateral salpingo-oophorectomy (TH + BSO), while 72 underwent myomectomy followed by supplemental TH + BSO. The group with direct hysterectomy had a higher average age than the group with prior myomectomy (47.20 ± 8.94 vs. 40.86 ± 5.88, p < 0.001). Among patients preoperatively diagnosed as uterine fibroids, patients with uLMS had a higher proportion of previous myomectomy (26.53% vs. 5.00%, p < 0.001), a larger uterine mass diameter on ultrasound (8.38 ± 3.39 cm vs. 6.41 ± 1.92 cm, p < 0.001), and richer hypervascularity (34.69% vs. 18%, p = 0.024) compared with LG-ESS. CONCLUSIONS Analysis of our data showed that a large proportion of uterine sarcomas, especially uLMS and LG-ESS, present mainly with uterine masses. Ultrasound features including a large uterine mass diameter and rich hypervascularity, and with a history of myomectomy may alert clinicians in suspicion of uLMS when compared with LG-ESS.
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Affiliation(s)
- Menghan Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China
| | - Shouzhen Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China.
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22
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Khan SR, Soomar SM, Asghari T, Ahmed A, Moosajee MS. Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years' clinical experience from a tertiary care center in Pakistan. BMC Cancer 2023; 23:510. [PMID: 37277708 DOI: 10.1186/s12885-023-11000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Uterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes. METHODS A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis. RESULTS Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival. CONCLUSION Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.
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Affiliation(s)
- Saqib Raza Khan
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Tamana Asghari
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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23
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Devins KM, Attygalle AD, Croce S, Vroobel K, Oliva E, McCluggage WG. Uterine Endometrial Stromal Tumors With Pure Low-Grade Morphology Harboring YWHAE::NUTM2 Fusions: Report of a Case Series Emphasizing Potential for High-Grade Transformation and Aggressive Behavior. Am J Surg Pathol 2023; 47:717-724. [PMID: 37032555 DOI: 10.1097/pas.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Uterine endometrial stromal sarcomas (ESS) with YWHAE::NUTM2 gene fusions are typically morphologically high-grade tumors composed of atypical round cells, sometimes associated with a low-grade fibromyxoid component; they are currently included in the category of high-grade ESS (HGESS). We report 5 morphologically pure low-grade endometrial stromal tumors harboring YWHAE::NUTM2 fusions, including 1 endometrial stromal nodule (ESN) and 4 low-grade endometrial stromal sarcomas (LGESS), an association only occasionally reported previously. Patients ranged from 30 to 51 (mean=43) years and tumors from 4.5 to 7.5 cm (mean=5.7). All were stage I at diagnosis (confined to the uterus). Microscopically, the 4 LGESS showed extensive "tongue-like" invasion of the myometrium, and the ESN was entirely confined to the endometrium with no myometrial invasion. All tumors were composed entirely of morphologically uniform bland ovoid cells resembling proliferative endometrial stroma. A fibromyxoid component was seen in 1 LGESS and the ESN; in the LGESS, this was the sole component. Atypical round cells characteristic of YWHAE::NUTM2 HGESS were not identified. Mitotic count ranged from <1 to 13 per 10 high-power fields (mean: 3). CD10 was positive in 2/4 (focal), estrogen receptor in 5/5 (focal=1; diffuse=4), progesterone receptor in 5/5 (focal=1; diffuse=4) and cyclin D1 was diffusely positive in 3/4. Follow-up was available in all 5 patients and ranged from 6 to 159 months (mean=72). Two patients with LGESS had recurrent disease at 15 and 155 months; 1 showed predominantly LGESS with rare round cells in the initial recurrence and pure HGESS in a subsequent recurrence, while the other patient's recurrent tumor was predominantly HGESS (90%) in a background of focal fibromyxoid LGESS (10%). Both patients rapidly progressed and died of disease within 5 months of high-grade recurrence. We show that rare cases of morphologically pure low-grade endometrial stromal tumors, some but not all with a fibromyxoid component, harbor YWHAE::NUTM2 fusions and may recur rapidly, with transformation to HGESS and aggressive behavior. Our findings suggest that at least a subset of YWHAE::NUTM2 HGESS evolves from LGESS. We suggest that cyclin D1 and CD10 staining should be performed in all LGESS. Diffuse staining for cyclin D1 and/or negative or focal staining for CD10 should suggest the possibility of a YWHAE::NUTM2 fusion, and appropriate molecular testing should be undertaken. Since no single morphological or immunohistochemical parameter is entirely sensitive for fusion status, we also suggest that testing for a YWHAE::NUTM2 gene fusion should be considered in all cases of LGESS and, if a fusion is present, this should raise the possibility of subsequent high-grade transformation and aggressive behavior, even though such cases should still be categorized as LGESS. Although seemingly rare, ESN and LGESS with YWHAE::NUTM2 fusions may be under-recognized due to a lack of routine fusion testing.
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Affiliation(s)
- Kyle M Devins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Esther Oliva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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24
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Zapardiel I, Gracia Segovia M, Macuks R, Mancari R, Achimas-Cadariu P, Corrado G, Bartusevicius A, Sukhin V, Muruzabal JC, Coronado Martín PJ, Gardella B, Piek JM, Concin N, Arab C, Papatheodorou D, Polterauer S, Iacoponi S, Nieto T, Lopez-Sanclemente MC, Trukhan H, Gil MM, Bakinovskaya I, Dalamanava A, Cucurull M, Rovski D, Baquedano L, Chiva L, Mardas M, Mavrichev SA, Klat J, Lopez de la Manzanara CA, Yildirim Y. Prognostic factors in patients with uterine sarcoma: the SARCUT study. Int J Gynecol Cancer 2023:ijgc-2022-004204. [PMID: 37192761 DOI: 10.1136/ijgc-2022-004204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE Uterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma. METHODS This international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007. RESULTS The 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93). CONCLUSION Incomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Ronalds Macuks
- Riga East Clinical University Hospital Latvian Oncology Center, Riga, Latvia
| | - Rosanna Mancari
- Gynecologic Oncology Department, IRCCS, Milan, Italy
- Gynecologic Oncology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patriciu Achimas-Cadariu
- Gynecologic Oncology Department, The Oncology Institute 'Prof Dr Ion Chiricuta' Cluj-Napoca, Cluj-Napoca, Romania
| | - Giacomo Corrado
- Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italy
| | - Arnoldas Bartusevicius
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vladyslav Sukhin
- Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine
- Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | - Juan C Muruzabal
- Gynecologic Oncology Unit, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Barbara Gardella
- Gynecologic Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jurgen M Piek
- Gynecologic Oncology Department, Catharina Hospital and Catharina Cancer Institute, Eindhoven, Netherlands
| | - Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical Univeristy, Innsbruck, Austria
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Clemente Arab
- Gynecologic Oncology Department, Hospital Luis Tisné. Universidad de Chile, Santiago, Chile
| | | | - Stephan Polterauer
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Teresa Nieto
- Gynecologic Oncology Department, Hospital Universitario Santa Cristina, Madrid, Spain
| | - Martha C Lopez-Sanclemente
- Gynecologic Oncology Department, Torrecárdenas Hospital Complex, Almeria, Andalucía, Spain
- Gynecologic Oncology Department, Clinica Diatros, Barcelona, Spain
| | - Hanna Trukhan
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Maria M Gil
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Irina Bakinovskaya
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Alena Dalamanava
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Marc Cucurull
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Dzmitry Rovski
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Laura Baquedano
- Gynecologic Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Marcin Mardas
- Department of Gynecological Oncology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | | | - Jaroslav Klat
- Obstetrics and Gynecology Department, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic
| | | | - Yusuf Yildirim
- Gynecologic Oncology Department, Tepecik Training and Research Hospital Clinics, Konak, Izmir, Turkey
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25
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Marrache K, Hennawi HA, Qadir S, Bedi A, Hou KY. When images don't explain reality: A case of an intravascular extension of an endometrial tumor. Glob Cardiol Sci Pract 2023; 2023:e202311. [PMID: 37351096 PMCID: PMC10282796 DOI: 10.21542/gcsp.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/10/2023] [Indexed: 06/24/2023] Open
Abstract
Endometrial stromal sarcoma is a rare mesenchymal tumor with the potential for intravascular metastases. We present the case of a 52-year-old female patient with a history of previously resected endometrial sarcoma who was found to have an inferior vena cava thrombus with intracardiac extension. Pathological assessment following resection revealed intravascular extension of an underlying endometrial stromal sarcoma. This case demonstrates the aggressive nature and intracardiac metastatic potential of endometrial sarcomas.
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Affiliation(s)
- Kyle Marrache
- Jefferson Abington Hospital, Abington, Pennsylvania, USA
| | | | - Shayan Qadir
- Jefferson Abington Hospital, Abington, Pennsylvania, USA
| | - Angad Bedi
- Jefferson Abington Hospital, Abington, Pennsylvania, USA
| | - Kevin Ye Hou
- Asplundh Cancer Pavilion – Sidney Kimmel Cancer Center, Willow Grove, Pennsylvania, USA
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26
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Roussel-Simonin C, Croce S, Guyon F, Llacer C, Ray-Coquard I, Meeus P, Genestie C, Taieb S, Malhaire C, Duffaud F, Pautier P. [Uterin sarcoma, high-grade stroma, indifferenciated, referential]. Bull Cancer 2023:S0007-4551(23)00161-3. [PMID: 37062646 DOI: 10.1016/j.bulcan.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023]
Abstract
High-grade endometrial stromal sarcoma (HGESS) and uterine undifferentiated sarcoma (UUS) are rare uterine malignancies arising from mesenchymal endometrial cells. They are characterized by aggressive behavior and poor prognosis. Median age of diagnostic is 55years. The most common symptoms are vaginal bleeding, abdominal pain, and pelvic mass. Approximately 65 % are diagnosed witch advance disease stage III or IV according to the International Federation of Gynecology and Obstetrics classification. Median overall survival is around 20months. The management of the disease must be discussed in multidisciplinary staff meetings. The standard management of HGESS and UUS is total hysterectomy with bilateral oophorectomy. Systematic lymphadenectomy is not recommended. Adjuvant therapies, such as chemotherapy and radiotherapy must be discussed. In case of oligo-metastasic disease, surgery of the primary tumor and metastasis must be discussed and if not operable the standard management is doxorubine-based chemotherapy.
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Affiliation(s)
| | - Sabrina Croce
- Institut Bergonié, département de pathologie, Bordeaux, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie, Bordeaux, France
| | - Carmen Llacer
- Institut du Cancer de Montpellier, département de radiothérapie, Montpellier, France
| | | | - Pierre Meeus
- Centre Léon-Bérard, département de chirurgie, Lyon, France
| | | | - Sophie Taieb
- Centre Oscar-Lambret, département de radiologie, Lille, France
| | | | - Florence Duffaud
- Gustave-Roussy, département d'oncologie médicale, Villejuif, France
| | - Patricia Pautier
- Gustave-Roussy, département d'oncologie médicale, Villejuif, France
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27
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Kerrison WGJ, Thway K, Jones RL, Huang PH. The biology and treatment of leiomyosarcomas. Crit Rev Oncol Hematol 2023; 184:103955. [PMID: 36893945 DOI: 10.1016/j.critrevonc.2023.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Leiomyosarcoma (LMS) is a soft tissue sarcoma of smooth muscle origin that can arise in multiple anatomical sites and is broadly classified as extra-uterine LMS or uterine LMS. There is substantial interpatient heterogeneity within this histological subtype, and despite multi-modal therapy, clinical management remains challenging with poor patient prognosis and few new therapies available. Here we discuss the current treatment landscape of LMS in both the localised and advanced disease setting. We further describe the latest advances in our evolving understanding of the genetics and biology of this group of heterogeneous diseases and summarise the key studies delineating the mechanisms of acquired and intrinsic chemotherapy resistance in this histological subtype. We conclude by providing a perspective on how novel targeted agents such as PARP inhibitors may usher in a new paradigm of biomarker-driven therapies that will ultimately impact the outcomes of patients with LMS.
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Affiliation(s)
- William G J Kerrison
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Khin Thway
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom.
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28
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Chen N, Gong M, Lai W, Ling L, Liu Q. Primary ovarian endometrial stromal sarcoma after hysterectomy associated with multiple organ invasion: A case report. Medicine (Baltimore) 2023; 102:e33306. [PMID: 36961184 PMCID: PMC10036030 DOI: 10.1097/md.0000000000033306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE Endometrial stromal sarcoma (ESS) is a rare disease in patients with uterine malignancies, accounting for <1%. Low-grade endometrial stromal sarcoma (LGESS) accounts merely 0.2% of gynecologic malignant tumor. Primary low-grade extrauterine endometrioid stromal sarcomas (LGEESS) is even more uncommon, with only a few documented case reports. We report a case of primary LGEESS exhibiting widely invasion in multiple organs after hysterectomy, which is the first case reported in Jiangsu Province of China. PATIENT CONCERNS A 42-year-old nulliparous female with dysgnosia presented with a moderate amount of irregular vaginal bleeding, abdominal pain and distension, and frequent urination for 2 days. Her surgical history included a total hysterectomy and bilateral salpingectomy for uterine fibroids 6 years ago. Ultrasonography and the abdominal and pelvic computed tomography scan detected some solid polycystic masses in the pelvic and abdominal cavities. DIAGNOSES The histopathology of the specimen confirmed the diagnosis of LESS in the absence of florid endometriosis. The patient was diagnosed with primary extrauterine endometrial stromal sarcoma at FIGO stage III. INTERVENTIONS Surgery and histopathology were performed. OUTCOME After surgery, the patient was maintained on leuprorelin acetate microspheres with sustained release for injection at 3.75 mg once every 4 weeks while refusing further radiotherapy. LESSONS The diagnosis of primary LGEESS is challenging mainly because of their unforeseen location and nongynecologic signs and symptoms. Total hysterectomy and bilateral salpingo-oophorectomy are recommended to LGESS, while additional resection for extrauterine disease depends on disease extent and resectability.
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Affiliation(s)
- Ningxin Chen
- Department of Obstetrics and Gynecology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Gong
- Department of Obstetrics and Gynecology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wen Lai
- Department of Obstetrics and Gynecology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ling Ling
- Department of Obstetrics and Gynecology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiaoling Liu
- Department of Obstetrics and Gynecology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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29
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Huss A, Klar M, Hasanov MF, Juhasz-Böss I, Bossart M. Prognostic factors and survival of patients with uterine sarcoma: a German unicenter analysis. Arch Gynecol Obstet 2023; 307:927-935. [PMID: 35780401 PMCID: PMC9984332 DOI: 10.1007/s00404-022-06515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Uterine sarcoma (US) as a histologically heterogeneous group of tumors is rare and associated with poor prognosis. Prognostic factors based on systematic data collection need to be identified to optimize patients' treatment. METHODS This unicenter, retrospective cohort study includes 57 patients treated at the University Hospital Freiburg, Germany between 1999 and 2017. Progression-free survival (PFS) and overall survival (OS) were calculated and visualized in Kaplan-Meier curves. Prognostic factors were identified using log-rank test and Cox regression. RESULTS 44 Leiomyosarcoma (LMS), 7 low-grade endometrial stromal sarcoma (LG-ESS), 4 high-grade ESS and 2 undifferentiated US patients were identified. The median age at time of diagnosis was 51.0 years (range 18-83). The median follow-up time was 35 months. PFS for the total cohort was 14.0 (95%-Confidence-Interval (CI) 9.7-18.3) and OS 36.0 months (95%-CI 22.1-49.9). Tumor pathology was prognostically significant for OS with LG-ESS being the most favorable (mean OS 150.3 months). In the multivariate analysis, patients over 52 years showed a four times higher risk for tumor recurrence (hazard ratio (HR) 4.4; 95%-CI 1.5-12.9). Progesterone receptor negativity was associated with a two times higher risk for death (HR 2.8; 95%-CI 1.0-7.5). For LMS patients age ≥ 52 years (p = 0.04), clear surgical margins (p = 0.01), FIGO stage (p = 0.01) and no application of chemotherapy (p = 0.02) were statistically significant factors for OS. CONCLUSION Tumor histology, age at time of diagnosis and progesterone receptor status were prognostic factors for US. Unfavorable OS in LMS patients was associated with advanced FIGO stage, suboptimal cytoreduction and application of chemotherapy.
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Affiliation(s)
- Alexandra Huss
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Mir Fuad Hasanov
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Michaela Bossart
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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Influence of Clinical and Surgical Factors on Uterine Carcinosarcoma Survival. Cancers (Basel) 2023; 15:cancers15051463. [PMID: 36900255 PMCID: PMC10001122 DOI: 10.3390/cancers15051463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of prognostic factors on the survival of patients diagnosed with uterine carcinosarcoma. METHODS A sub-analysis of the SARCUT study, a multicentric retrospective European study, was carried out. We selected 283 cases of diagnosed uterine carcinosarcoma for the present study. Prognosis factors influencing survival were analyzed. RESULTS Significant prognostic factors for overall survival were: incomplete cytoreduction (HR = 4.02; 95%CI = 2.68-6.18), FIGO stages III and IV (HR = 3.21; 95%CI = 1.83-5.61), tumor persistence after any treatment (HR = 2.90; 95%CI = 1.97-4.27), presence of extrauterine disease (HR = 2.62; 95%CI = 1.75-3.92), a positive resection margin (HR = 1.56; 95%CI = 1.05-2.34), age (HR = 1.02; 95%CI = 1.00-1.05), and tumor size (HR = 1.01; 95%CI = 1.00-1.01). Significant prognostic factors for disease-free survival were: incomplete cytoreduction (HR = 3.00; 95%CI = 1.67-5.37), tumor persistence after any treatment (HR = 2.64; 95%CI = 1.81-3.86), FIGO stages III and IV (HR = 2.33; 95%CI = 1.59-3.41), presence of extrauterine disease (HR = 2.13; 95%CI = 1.44-3.17), administration of adjuvant chemotherapy (HR = 1.84; 95%CI = 1.27-2.67), a positive resection margin (HR = 1.65; 95%CI = 1.11-2.44), presence of LVSI (HR = 1.61; 95%CI = 1.02-2.55), and tumor size (HR = 1.00; 95%CI = 1.00-1.01). CONCLUSIONS Incomplete cytoreduction, presence of tumor residual after treatment, advanced FIGO stage, extrauterine disease, and tumor size are significant prognostic factors decreasing disease-free survival and overall survival of patients with uterine carcinosarcoma.
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Du J, Cheng Y, Hu D, Xing Y, Yue L, He R, Li H, Liu C, Liang X, Yang Y. A nomogram-based overall survival stratification to identify uterine sarcoma patients without distant metastases who may benefit from adjuvant radiotherapy. Gynecol Oncol 2023; 169:17-26. [PMID: 36469973 DOI: 10.1016/j.ygyno.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Adjuvant radiotherapy has been commonly performed in uterine sarcoma patients, but its role in overall survival (OS) remains controversial. Therefore, our study aimed to build a nomogram-based prognostic stratification to identify uterine sarcoma patients who might benefit from adjuvant radiotherapy. METHODS Uterine sarcoma patients without distant metastases between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The LASSO Cox regression was performed to identify essential prognostic predictors and a nomogram was built to predict the 1-, 3-, and 5-year OS. Receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA) were used to validate the nomogram. Finally, prognostic stratification was performed by decision tree analysis based on the total points of the nomogram. RESULTS 2871 patients with uterine sarcoma were included. Preliminary analysis suggested that adjuvant radiotherapy failed to provide an OS benefit for the total population without our nomogram. The built nomogram showed good discrimination and calibration abilities to predict the OS in uterine sarcoma patients and the patients were stratified into three risk groups based on the nomogram. For patients in the high-risk group, adjuvant radiotherapy significantly improved the 5-year OS and median survival time by 26.4% and 17 months, respectively (P < 0.001); while radiotherapy failed to improve the survival outcomes of patients in the low- and intermediate-risk groups. CONCLUSIONS The nomogram-based prognostic stratification provides preliminary characterization of uterine sarcoma patients who may benefit from radiotherapy. The newly defined high-risk patients may gain significant OS benefit from adjuvant radiotherapy.
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Affiliation(s)
- Junhong Du
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Yuemei Cheng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Dan Hu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Yijuan Xing
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ling Yue
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ruifen He
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Hongli Li
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Chang Liu
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xiaolei Liang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
| | - Yongxiu Yang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
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He X, Dong Q, Weng C, Gu J, Yang Q, Yang G. Trends in incidence, survival and initial treatments of gynecological sarcoma: a retrospective analysis of the United States subpopulation. BMC Womens Health 2023; 23:10. [PMID: 36624439 PMCID: PMC9830743 DOI: 10.1186/s12905-023-02161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To estimate the incidence, prevalence and incidence-based mortality in patients with gynecologic sarcoma (GS), and described the trends of survival and initial treatments in the US by using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS GS cases aged 20 years or older between 1975 and 2015 were identified from SEER 9 registries. Incidence, prevalence, and incidence-based mortality were estimated, all rates were age adjusted to the 2000 US standard population and presented as per 100,000 persons. Annual percentage change (APC) and average APC (AAPC) were calculated to describe the trends. In addition, stage distribution, cancer-specific survival (CSS) and initial treatment pattern over time were also reported. RESULTS The overall age-adjusted incidence of GS increased from 2.38 to 3.41 per 100,000 persons from 1975 to 2015, with an AAPC of 1.0 (P < 0.05), and the AAPC increased to 1.3 (P < 0.05) in the last decade. The incidence of population aged ≥ 55 years was three or more times than that of population aged 20-54 year from 1975 to 2015. Corpus and uterus GS was the main subtype, and it increased significantly during last three decades (an APC of 1.5). In addition, the prevalence of corpus and uterus GS increased mostly among all GSs. The incidence of GS with regional and distant stages increased pronouncedly, but not for local stage. GS cases showed increasing 3-year and 5-year CSS rates except for other sites GS. Approximately 87.7% GS cases received surgery during the first-course treatment, but the proportion decreased over years. In contrast, the proportion of receiving multiple treatment modalities increased. CONCLUSIONS The incidence of GS increased significantly with improved survival, which might due to the strategy of combination of multiple treatment. However, no obvious improvement on the early detection of GS was found, which should be facilitated to further improve the prognosis of GS.
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Affiliation(s)
- Xi He
- Department of Obstetrics and Gynecology, The People’s Hospital of Sanjiang Dong Autonomous County, Liuzhou, 545500 China
| | - Qiang Dong
- Department of General Medicine, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Changfang Weng
- Department of Oncology, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Jianfen Gu
- Department of Clinical Nutrition, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Qiao Yang
- Department of Ultrasound, The 941St Hospital of the PLA Joint Logistic Support Force, Xining, 810007 China
| | - Guangrong Yang
- Department of Oncology, The People’s Hospital of Qijiang District, Chongqing, 401420 China
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Pantelić M, Gvozdenovic L, Panjković M, Stojić M, Stajić D, Petrić A, Trajković SP, Trenkić M, Simić D, Živadinović L, Živadinović A. Manifestation of an undifferentiated uterine sarcoma in a 51 years old patient and its prognosis: A case report. Medicine (Baltimore) 2022; 101:e32552. [PMID: 36596037 PMCID: PMC9803412 DOI: 10.1097/md.0000000000032552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Undifferentiated uterine sarcoma is a rare histological subtype of uterine sarcoma. This study aimed to summarize the clinical and pathological presentation of this case. CASE REPORT A 51-years-old patient was admitted to the clinic because of severe pain in the lower abdomen, and scanty bleeding from the genitals. Gynecological examination revealed an enlarged uterus. Conventional and Doppler transvaginal sonography detected a tumorously altered uterus with a maximum diameter of 20 cm a tumefaction with unclear borders and a diameter of 10 cm, with hyperechoic and hypoechoic fields within the tumefaction, presenting pathological vascularization and reduced values of the (Pulsatile index ≤ 1) and (Resistance index ≤ 0.40). Preoperatively, the chest, abdomen, and pelvis were examined. The patient underwent surgery and total abdominal hysterectomy with bilateral salpingo-oophorectomy, and partial omentectomy, with complete removal of the tumor. A pathohistological diagnosis, of undifferentiated uterine sarcoma, was made by excluding other types of uterine sarcomas. At the control examination after completion of chemotherapy, recurrence was ascertained. CONCLUSION undifferentiated uterine sarcoma is an aggressive malignant tumor that in most cases shows rapid progression of the disease after complete resection of the tumor, with a poor prognosis.
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Affiliation(s)
- Miloš Pantelić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- University Clinical Center of Vojvodina, Clinic for Obstetrics and Gynecology, Novi Sad, Serbia
| | - Ljiljana Gvozdenovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- University Clinical Center of Vojvodina, Clinic for Anesthesia, Intensive Therapy and Pain Therapy, Novi Sad, Serbia
| | - Milana Panjković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- University Clinical Center of Vojvodina, Department of Pathology and Histology, Novi Sad, Serbia
| | - Marko Stojić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- University Clinical Center of Vojvodina, Clinic for Obstetrics and Gynecology, Novi Sad, Serbia
| | - Dragan Stajić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- University Clinical Center of Vojvodina, Clinic for Obstetrics and Gynecology, Novi Sad, Serbia
| | - Aleksandra Petrić
- Faculty of Medicine University of Niš, Niš, Serbia
- University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
| | - Sonja Pop Trajković
- Faculty of Medicine University of Niš, Niš, Serbia
- University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
| | - Milan Trenkić
- Faculty of Medicine University of Niš, Niš, Serbia
- University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
| | - Dušan Simić
- Health Center Niš, Womens Health Protection Office, Niš, Serbia
| | - Lazar Živadinović
- University Clinical Center Niš, Clinic for Gynecology and Obstetrics, Niš, Serbia
- * Correspondence: Lazar Živadinović, University Clinical center Niš, Clinic for gynecology and obstetrics, Radoja Dakica Street No. 24, Niš 18000, Serbia (e-mail: )
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Adjuvant Therapy in Node-Positive Endometrial Cancer: A Focus on Chemotherapy. Curr Oncol Rep 2022; 24:1677-1683. [PMID: 36417134 DOI: 10.1007/s11912-022-01327-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In advanced-stage and high-risk endometrial cancer, adjuvant treatment is the standard of care and typically includes chemotherapy with or without radiotherapy. Debate continues over the optimal use of these two treatment modalities together or separately. This review covers the historical literature leading to the current recommendation for adjuvant chemotherapy, in addition to looking forward to the relatively new field of targeted molecular treatment. RECENT FINDINGS The review covers recent phase III trials comparing chemotherapy to radiotherapy in high-risk endometrial cancer. Additionally, the era of genomic medicine has a new foothold in endometrial cancer, and the review covers new discoveries on molecular classification and prognostic implications. Fortunately, the majority of endometrial cancer has a good prognosis. For advanced-stage and high-risk histologies, the prognosis can be guarded, with adjuvant treatment improving outcomes. Gynecologic oncologists continue to debate the optimal treatment modality/modalities, a debate which will likely become more robust as the field of molecular treatment in endometrial cancer evolves.
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Huang TT, Chen CM, Lan YW, Lin SS, Choo KB, Chong KY. Blockade of c-Met-Mediated Signaling Pathways by E7050 Suppresses Growth and Promotes Apoptosis in Multidrug-Resistant Human Uterine Sarcoma Cells. Int J Mol Sci 2022; 23:ijms232314884. [PMID: 36499211 PMCID: PMC9740914 DOI: 10.3390/ijms232314884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
E7050 is a potent inhibitor of c-Met receptor tyrosine kinase and has potential for cancer therapy. However, the underlying molecular mechanism involved in the anti-cancer property of E7050 has not been fully elucidated. The main objective of this study was to investigate the anti-tumor activity of E7050 in multidrug-resistant human uterine sarcoma MES-SA/Dx5 cells in vitro and in vivo, and to define its mechanisms. Our results revealed that E7050 reduced cell viability of MES-SA/Dx5 cells, which was associated with the induction of apoptosis and S phase cell cycle arrest. Additionally, E7050 treatment significantly upregulated the expression of Bax, cleaved PARP, cleaved caspase-3, p21, p53 and cyclin D1, while it downregulated the expression of survivin and cyclin A. On the other hand, the mechanistic study demonstrated that E7050 inhibited the phosphorylation of c-Met, Src, Akt and p38 in HGF-stimulated MES-SA/Dx5 cells. Further in vivo experiments showed that treatment of athymic nude mice carrying MES-SA/Dx5 xenograft tumors with E7050 remarkably suppressed tumor growth. E7050 treatment also decreased the expression of Ki-67 and p-Met, and increased the expression of cleaved caspase-3 in MES-SA/Dx5 tumor sections. Therefore, E7050 is a promising drug that can be developed for the treatment of multidrug-resistant uterine sarcoma.
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Affiliation(s)
- Tsung-Teng Huang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Biomedical Sciences, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center and the Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Ying-Wei Lan
- Division of Pulmonary Biology, The Perinatal Institute of Cincinnati Children’s Research Foundation, Cincinnati, OH 45229, USA
| | - Song-Shu Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan
- Hyperbaric Oxygen Medical Research Lab, Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Kong-Bung Choo
- Centre for Stem Cell Research, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia
| | - Kowit-Yu Chong
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Biomedical Sciences, Division of Biotechnology, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Hyperbaric Oxygen Medical Research Lab, Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Centre for Stem Cell Research, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Keelung, Keelung City 20401, Taiwan
- Correspondence: ; Tel.: +886-2211-8393
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Dai M, Liu Y, Hu Y, Li G, Zhang J, Xiao Z, Lv F. Combining multiparametric MRI features-based transfer learning and clinical parameters: application of machine learning for the differentiation of uterine sarcomas from atypical leiomyomas. Eur Radiol 2022; 32:7988-7997. [PMID: 35583712 DOI: 10.1007/s00330-022-08783-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/19/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To explore the feasibility and effectiveness of machine learning (ML) based on multiparametric magnetic resonance imaging (mp-MRI) features extracted from transfer learning combined with clinical parameters to differentiate uterine sarcomas from atypical leiomyomas (ALMs). METHODS The data of 86 uterine sarcomas between July 2011 and December 2019 and 86 ALMs between June 2013 and June 2017 were retrospectively reviewed. We extracted deep-learning features and radiomics features from T2-weighted imaging (T2WI) and diffusion weighted imaging (DWI). The two feature extraction methods, transfer learning and radiomics, were compared. Random forest was adopted as the classifier. T2WI features, DWI features, combined T2WI and DWI (mp-MRI) features, and combined clinical parameters and mp-MRI features were applied to establish T2, DWI, T2-DWI, and complex multiparameter (mp) models, respectively. Predictive performance was assessed with the area under the receiver operating characteristic curve (AUC). RESULTS In the test set, the T2, DWI, T2-DWI and complex mp models based on transfer learning (AUCs range from 0.76 to 0.81, 0.80 to 0.88, 0.85 to 0.92, and 0.94 to 0.96, respectively) outperformed the models based on radiomics (AUCs of 0.73, 0.76, 0.79, and 0.92, respectively). Moreover, the complex mp model showed the best prediction performance, with the Resnet50-complex mp model achieving the highest AUC (0.96) and accuracy (0.87). CONCLUSIONS Transfer learning is feasible and superior to radiomics in the differential diagnosis of uterine sarcomas and ALMs in our dataset. ML models based on deep learning features of nonenhanced mp-MRI and clinical parameters can achieve good diagnostic efficacy. KEY POINTS • The ML model combining nonenhanced mp-MRI features and clinical parameters can distinguish uterine sarcomas from ALMs. • Transfer learning can be applied to differentiate uterine sarcomas from ALMs and outperform radiomics. • The most accurate prediction model was Resnet50-based transfer learning, built with the deep-learning features of mp-MRI and clinical parameters.
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Affiliation(s)
- Mengying Dai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Yang Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yan Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Guanghui Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Jian Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Zhibo Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Fajin Lv
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road, Yuzhong District, Chongqing, 400016, China.
- Institute of Medical Data, Chongqing Medical University, Chongqing, 400016, China.
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Nucci MR, Webster F, Croce S, George S, Howitt BE, Ip PPC, Lee CH, Rabban JT, Soslow RA, van der Griend R, Lax SF, McCluggage WG. Data Set for Reporting of Uterine Malignant and Potentially Malignant Mesenchymal Tumors: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S44-S63. [PMID: 36305534 DOI: 10.1097/pgp.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) seeks to produce standardized, evidence-based protocols for the reporting of tumors with the aim of ensuring that all cancer reports generated worldwide will be of similar high quality and record the same elements. Herein, we describe the development of the data set for the reporting of uterine malignant and potentially malignant mesenchymal tumors by a panel of expert pathologists and a single clinician and provide the commentary and rationale for the inclusion of core and noncore elements. This data set, which incorporates the recent updates from the 5th edition of the World Health Organization Classification of Female Genital Tumors, addresses several subjects of debate including which mesenchymal tumors should be graded, how to document extent of invasion, mitotic counts, and the role of ancillary testing in tumor diagnosis and patient management. The inclusion of elements is evidence-based or based on consensus of the expert panel with clinical relevance being the guiding standard.
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de Almeida BC, dos Anjos LG, Dobroff AS, Baracat EC, Yang Q, Al-Hendy A, Carvalho KC. Epigenetic Features in Uterine Leiomyosarcoma and Endometrial Stromal Sarcomas: An Overview of the Literature. Biomedicines 2022; 10:biomedicines10102567. [PMID: 36289829 PMCID: PMC9599831 DOI: 10.3390/biomedicines10102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
There is a consensus that epigenetic alterations play a key role in cancer initiation and its biology. Studies evaluating the modification in the DNA methylation and chromatin remodeling patterns, as well as gene regulation profile by non-coding RNAs (ncRNAs) have led to the development of novel therapeutic approaches to treat several tumor types. Indeed, despite clinical and translational challenges, combinatorial therapies employing agents targeting epigenetic modifications with conventional approaches have shown encouraging results. However, for rare neoplasia such as uterine leiomyosarcomas (LMS) and endometrial stromal sarcomas (ESS), treatment options are still limited. LMS has high chromosomal instability and molecular derangements, while ESS can present a specific gene fusion signature. Although they are the most frequent types of “pure” uterine sarcomas, these tumors are difficult to diagnose, have high rates of recurrence, and frequently develop resistance to current treatment options. The challenges involving the management of these tumors arise from the fact that the molecular mechanisms governing their progression have not been entirely elucidated. Hence, to fill this gap and highlight the importance of ongoing and future studies, we have cross-referenced the literature on uterine LMS and ESS and compiled the most relevant epigenetic studies, published between 2009 and 2022.
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Affiliation(s)
- Bruna Cristine de Almeida
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Laura Gonzalez dos Anjos
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Andrey Senos Dobroff
- UNM Comprehensive Cancer Center (UNMCCC), University of New Mexico, Albuquerque, NM 87131, USA
- Division of Molecular Medicine, Department of Internal Medicine, (UNM) School of Medicine, UNM Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Edmund Chada Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
- Correspondence: ; Tel.: +55-011-3061-7486
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Wang F, Dai X, Chen H, Hu X, Wang Y. Clinical characteristics and prognosis analysis of uterine sarcoma: a single-institution retrospective study. BMC Cancer 2022; 22:1050. [PMID: 36207687 PMCID: PMC9540718 DOI: 10.1186/s12885-022-10129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Uterine sarcomas are rare and aggressive gynaecologic malignancies, characterized by a relatively high recurrence rate and poor prognosis. The aim of this study was to investigate the clinicopathological features and explore the prognostic factors of these malignancies. Methods This was a single-institution, retrospective study. We reviewed the medical records of 155 patients with pathologically confirmed uterine sarcomas including uterine leiomyosarcoma (ULMS), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma (UUS) and adenosarcoma (AS) between 2006 and 2022. A total of 112 patients who underwent surgery between January 2006 and April 2019 were included in the survival analysis. The current study recorded the clinicopathological, treatment and outcome data to determine clinical characteristics and survival. Results The most common histopathological type was ULMS (63/155, 40.64%), followed by LG-ESS (56/155, 36.13%) and HG-ESS (16/155, 10.32%). The mean age at diagnosis of all patients was 49.27±48.50 years and 32.90% (51/155) of patients were postmenopausal. Fifteen patients underwent fast-frozen sectioning, 63(54.78%) were diagnosed with malignancy, 29(25.22%) were highly suspected of malignancy that needed further clarification and 23(14.84%) were diagnosed with benign disease. A total of 124(80%) patients underwent total hysterectomy (TH) and salpingo-oophorectomy. Multivariate analyses showed that histological type and tumour size were independent prognostic factors both for overall survival (OS) (p<0.001 and P=0.017, respectively) and progression-free survival (PFS) (p<0.001 and P=0.018, respectively). Tumour stage was only significantly associated with PFS (P=0.002). Elevated preoperative NLR, PLR and postmenopausal status were significantly correlated with shorter PFS and OS in univariate analysis, but no statistically significant difference was found in multivariate analysis. Conclusions In patients with uterine sarcoma, in comparison to LMS and LG-ESS, UUS and HG-ESS tend to present as more aggressive tumour with poorer outcomes. Furthermore, larger tumour (>7.5 cm) were an important predictor of shorter PFS and OS.
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Affiliation(s)
- Fang Wang
- Department of Pathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinyue Dai
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China
| | - Huijun Chen
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China
| | - Xiaoli Hu
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China.
| | - Yuanqiu Wang
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China.
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Sharma A, Sancheti S, Somal P, Sali A, Dwivedi A, Tahlan S. The Flower Vase Uterus: A Rare Presentation. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Piątek S, Szymusik I, Dańska-Bidzińska A, Ołtarzewski M, Trojan G, Bidziński M. Fertility-Sparing Management May Be Considered in Young Women with Uterine Sarcoma. J Clin Med 2022; 11:jcm11164761. [PMID: 36012998 PMCID: PMC9410102 DOI: 10.3390/jcm11164761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Uterine sarcomas occur very rarely in young women. Hysterectomy, which is a standard treatment, may not be acceptable for those patients, especially nulliparous women. Fertility-sparing management may be an alternative. The aim of the study was to assess fertility-sparing management in patients with uterine sarcoma. Eleven patients were eligible for the study. Histopathologic types of the tumor included: adenosarcoma (n = 3), low-grade endometrial stromal sarcoma (n = 3), low-grade myofibroblastic sarcoma (n = 1), leiomyosarcoma (n = 1), leiomyosarcoma myxoides (n = 1), rhabdomyosarcoma (n = 1), high grade endometrial stromal sarcoma (n = 1). The mean age of the patients at the time of diagnosis was 27.4 years (range: 17–35) and the average follow-up 61 months (range: 12–158). Six patients received adjuvant treatment: megestrol (n = 5) and chemotherapy (n = 1). Recurrence was diagnosed in five cases. Median time to recurrence was 35 months (range: 8–90). Three patients conceived spontaneously following treatment and gave at least one live birth. In total, five full-term pregnancies were recorded and five healthy children were born. Fertility-sparing management may be considered in some patients with uterine sarcoma; however, it may not be appropriate in high-grade endometrial stromal sarcoma. Patients with adenosarcoma may have a low chance of childbearing.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, the Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
- Correspondence:
| | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
| | - Anna Dańska-Bidzińska
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Gabriela Trojan
- Students’ Scientific Group, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
| | - Mariusz Bidziński
- Department of Gynecologic Oncology, the Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
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Hao Z, Yang S. The role of postoperative radiotherapy in patients with uterine sarcomas: A PSM-IPTW analysis based on SEER database. Front Surg 2022; 9:985654. [PMID: 36017510 PMCID: PMC9395938 DOI: 10.3389/fsurg.2022.985654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe optimal adjuvant therapy for uterine sarcomas remains poorly determined due to its rarity and histological diversity. The purpose of the study is to explore and characterize the association between utilization of radiotherapy and survival outcome in patients with surgically resected uterine sarcomas.MethodsWe collected data regarding uterine sarcomas which were confirmed after total hysterectomy between 2010 and 2018 period from the latest version of the Surveillance, Epidemiology, and End Results (SEER) database. Initially, 1-, 3- and 5-year survival rate were calculated to predict potential risk factors and possible role of adjuvant chemotherapy and radiotherapy. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) technique were employed to balance confounding factors in the utilization of additional therapy. Multivariate and exploratory subgroup analyses were respectively conducted to evaluate the impact of adjuvant therapy on overall survival (OS) and cause-specific survival (CSS).ResultsA total of 2897 patients were enrolled in the analysis. Survival benefit at 1-, 3-and 5-year after initial treatment was observed in the group of radiotherapy given, however, poorer prognosis in the group of chemotherapy administration. Accordingly, chemotherapy was enrolled as a confounding factor when stratifying and matching patients by receipt of radiotherapy. Prior to and after PSM-IPTW adjustment, radiotherapy both demonstrated beneficial effect on OS and CSS based on multivariate analysis. Further subgroup analysis indicated radiotherapy improved OS and CSS among a subset of patients in stage II-IV, particularly with uterine leiomyosarcoma, tumor grade IV, bigger tumor size than 100 mm and even with chemotherapy administration.ConclusionsAdjuvant radiotherapy in uterine sarcomas after hysterectomy might be underutilized, and proper use of adjuvant radiotherapy combined with chemotherapy after surgery in advanced-stage and high-risk patients might improve survival.
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Affiliation(s)
- Zhimin Hao
- Department of Gynecology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
- Correspondence: Zhimin Hao Sufen Yang
| | - Sufen Yang
- Department of Gynecology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- Correspondence: Zhimin Hao Sufen Yang
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Smith ES, Jansen C, Miller KM, Chiang S, Alektiar KM, Hensley ML, Mueller JJ, Abu-Rustum NR, Leitao MM. Primary characteristics and outcomes of newly diagnosed low-grade endometrial stromal sarcoma. Int J Gynecol Cancer 2022; 32:882-890. [PMID: 35641004 PMCID: PMC9256804 DOI: 10.1136/ijgc-2022-003383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess potential predictive variables for nodal metastasis and survival outcomes in patients with newly diagnosed, low-grade endometrial stromal sarcoma. METHODS We performed a single-institution, retrospective analysis of consecutive patients with newly diagnosed, low-grade endometrial stromal sarcoma who presented between January 1, 1980 and December 31, 2019 and underwent hysterectomy at our institution or presented within 3 months of primary surgery elsewhere before recurrence. Patients who presented to our institution only at recurrence were excluded. Patients with <3 months of follow-up were excluded from survival analyses. RESULTS We identified 127 consecutive patients for analysis. Median age at diagnosis was 48 years (range 19-88 years); 91 (74.6%) of 127 were pre-menopausal; and 74 (58.3%) of 127 had uterine-confined, stage I tumors. Of 56 patients (44.1%) who underwent lymph node sampling, 10 (17.9%) had nodal metastasis. Of the 10 with nodal metastasis, 1 (10%) did not have lymphadenopathy or extra-uterine disease, 4 (40%) had lymphadenopathy only, 1 (10%) had extra-uterine disease only, and 4 (40%) had both. Among the 29 patients without apparent extra-uterine disease or gross lymphadenopathy, there was one occult lymph node metastasis (3.4%). Gross lymphadenopathy at time of surgery was predictive for lymph node metastasis (p<0.001). Median follow-up was 69 months (range 4-336) for the 95 patients included in the survival analyses. The 5-year progression-free survival and disease-specific survival rates were 79.8% and 90.8%, respectively. Patients with stage I tumors had longer progression-free survival than those with stage II-IV disease (p<0.001); there was no difference in disease-specific survival (p=0.63). Post-operative observation versus adjuvant therapy with hormone blockade or radiation therapy did not result in progression-free survival differences for stage I or completely resected stage II-IV disease (p=0.50 and p=0.81, respectively). Similarly, there was no disease-specific survival difference for completely resected stage II-IV disease (p=0.3). CONCLUSIONS Lymph node dissection in patients with low-grade endometrial stromal sarcoma should be reserved for those with clinically suspicious lymphadenopathy. Disease stage correlated with progression-free survival but not disease-specific survival. Post-operative therapy did not improve progression-free survival or disease-specific survival.
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Affiliation(s)
- Evan S Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Corinne Jansen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kathryn M Miller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
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Tsatsaris G, Fasoulakis Z, Koutras A, Ntounis T, Samara AA, Syllaios A, Diamantis A, Kouroupi M, Stamos C, Kontomanolis EN. Primary Cervical Carcinosarcoma: Report of a Rare Case. Surg J (N Y) 2022; 8:e174-e178. [PMID: 35928548 PMCID: PMC9345680 DOI: 10.1055/s-0042-1744152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/31/2022] [Indexed: 11/04/2022] Open
Abstract
Background
Carcinosarcomas are malignant mixed Müllerian tumors (MMMT), containing both epithelial and mesenchymal components. Carcinosarcomas of the uterine cervix comprise an extremely rare histopathological entity, with less than 150 cases reported in the literature to date.
Materials and Methods
A 79-year-old postmenopausal female patient was referred to our gynecological department due to a pelvic mass and vaginal bleeding. A cervical curettage was performed and the histological report revealed a malignant neoplasm with high cellularity consisting of two components; the first was a chondrosarcoma and the latter a adenocarcinoma. A diagnosis of MMMT was confirmed through immunohistochemical (IHC) staining. Neoadjuvant chemotherapy and radiotherapy were implemented, and a year later the patient underwent a radical hysterectomy and oncological pelvic lymph node dissection. She remains disease-free 12 months postoperatively.
Conclusion
Primary cervical carcinosarcomas are extremely rare tumors demonstrating a bipartite profile. Preoperative diagnosis with appropriate immunochemistry testing of this rare entity is crucial to decision making.
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Affiliation(s)
- Georgios Tsatsaris
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Zacharias Fasoulakis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Antonios Koutras
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Thomas Ntounis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Athina A. Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Athanasios Syllaios
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Charilaos Stamos
- Department of Pathology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
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Devaud N, Vornicova O, Abdul Razak AR, Khalili K, Demicco EG, Mitric C, Bernardini MQ, Gladdy RA. Leiomyosarcoma: Current Clinical Management and Future Horizons. Surg Oncol Clin N Am 2022; 31:527-546. [PMID: 35715148 DOI: 10.1016/j.soc.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leiomyosarcomas are soft tissue tumors that are derived from smooth muscle mainly in the pelvis and retroperitoneum. Percutaneous biopsy is paramount to confirm diagnosis. Imaging is necessary to complete clinical staging. Multimodal treatment should be directed by expert sarcoma multidisciplinary teams that see a critical volume of these rare tumors. Surgery is the mainstay of curative intent treatment; however due to its high metastatic progression, there may be a benefit for neoadjuvant systemic treatment. Adjuvant systemic treatment has no proven disease-free survival, and its main role is in the palliative setting to potentially prolong overall survival.
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Affiliation(s)
- Nicolas Devaud
- Instituto Oncologico Fundacion Arturo Lopez Perez (FALP), Santiago, Chile
| | - Olga Vornicova
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Korosh Khalili
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth G Demicco
- Department of Laboratory Medicine and Pathobiology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Cristina Mitric
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca A Gladdy
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Division of General Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
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Aparicio-López D, Estrada-Lázaro IM. Metástasis parietal de neoplasia intraabdominal. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Los sarcomas uterinos corresponden al 7-8 % de todas las neoplasias uterinas1. La edad promedio de presentación es entre la cuarta y quinta década de la vida. Su diagnóstico suele ser tardío porque sus manifestaciones clínicas son inespecíficas y silentes. Histológicamente los sarcomas se dividen en carcinosarcomas (50 %), leiomiosarcomas (30 %), sarcomas del estroma endometrial (15 %) y sarcomas indiferenciados (5 %) 2.
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Safety and feasibility of laterally extended endopelvic resection for sarcoma in the female genital tract: a prospective cohort study. Obstet Gynecol Sci 2022; 65:355-367. [PMID: 35754364 PMCID: PMC9304442 DOI: 10.5468/ogs.22071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to evaluate the safety and feasibility of laterally extended endopelvic resection (LEER) for sarcoma in the female genital tract. Methods We prospectively recruited gynecologic cancer patients with sarcoma arising from female genital tract who underwent LEER at Seoul National University Hospital from December 2016 to March 2021. Clinicopathologic characteristics, surgical outcomes including postoperative complications and pain control, and survival outcomes of the patients were investigated. Results A total of nine patients were registered for this study. The median age was 56 years. Carcinosarcoma (n=2, 22%), leiomyosarcoma (n=2, 22%), and undifferentiated uterine sarcoma (n=2, 22%) were common histology types. Complete resection was achieved in 88.9%. The most common location of pelvic sidewall tumors was infra-iliac acetabulum (66.7%). The pathologic outcome showed a median tumor size of 9.0 cm and internal iliac vessel resection with pelvic sidewall muscle was performed in all patients. The median estimated blood loss was 1,600 mL (range, 300–22,300), and the patients were postoperatively admitted to the intensive care unit for median 1 day (range, 0–8). Complete response was observed in 44.4% (4/9) in radiologic studies after LEER, and median progression-free survival, treatment-related survival, and overall survival were 3.3, 19.6, and 98.9 months, respectively. Conclusion LEER was feasible and safe in treating recurrent sarcoma presenting pelvic sidewall invasion with acceptable survival outcomes and manageable postoperative complications.
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Vanbraband J, Van Damme N, Bouche G, Silversmit G, De Geyndt A, de Jonge E, Jacomen G, Goffin F, Denys H, Amant F. Completeness and selection bias of a Belgian multidisciplinary, registration-based study on the EFFectiveness and quality of Endometrial Cancer Treatment (EFFECT). BMC Cancer 2022; 22:600. [PMID: 35650593 PMCID: PMC9161534 DOI: 10.1186/s12885-022-09671-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the aim of obtaining more uniformity and quality in the treatment of corpus uteri cancer in Belgium, the EFFECT project has prospectively collected detailed information on the real-world clinical care offered to 4063 Belgian women with primary corpus uteri cancer. However, as data was collected on a voluntary basis, data may be incomplete and biased. Therefore, this study aimed to assess the completeness and potential selection bias of the EFFECT database. METHODS Five databases were deterministically coupled by use of the patient's national social security number. Participation bias was assessed by identifying characteristics associated with hospital participation in EFFECT, if any. Registration bias was assessed by identifying patient, tumor and treatment characteristics associated with patient registration by participating hospitals, if any. Uni- and multivariable logistic regression were applied. RESULTS EFFECT covers 56% of all Belgian women diagnosed with primary corpus uteri cancer between 2012 and 2016. These women were registered by 54% of hospitals, which submitted a median of 86% of their patients. Participation of hospitals was found to be biased: low-volume and Walloon-region centers were less likely to participate. Registration of patients by participating hospitals was found to be biased: patients with a less favorable risk profile, with missing data for several clinical-pathological risk factors, that did not undergo curative surgery, and were not discussed in a multidisciplinary tumor board were less likely to be registered. CONCLUSIONS Due to its voluntary nature, the EFFECT database suffers from a selection bias, both in terms of the hospitals choosing to participate and the patients being included by participating institutions. This study, therefore, highlights the importance of assessing the selection bias that may be present in any study that voluntarily collects clinical data not otherwise routinely collected. Nevertheless, the EFFECT database covers detailed information on the real-world clinical care offered to 56% of all Belgian women diagnosed with corpus uteri cancer between 2012 and 2016, and may therefore act as a powerful tool for measuring and improving the quality of corpus uteri cancer care in Belgium.
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Affiliation(s)
- Joren Vanbraband
- Biomedical Sciences Group, Department of Oncology, Unit of Gynecological Oncology, KU Leuven, ON4 Herestraat 49, box 1045, 3000, Leuven, Belgium
| | - Nancy Van Damme
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Gauthier Bouche
- The Anticancer Fund, Brusselsesteenweg 11, 1860, Meise, Belgium
| | - Geert Silversmit
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Anke De Geyndt
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Eric de Jonge
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Schiepse Bos 6, 3600, Genk, Belgium
| | - Gerd Jacomen
- Laboratory of Pathological Anatomy, AZ Sint-Maarten, Liersesteenweg 435, 2800, Mechelen, Belgium
| | - Frédéric Goffin
- Department of Obstetrics and Gynecology, CHR de La Citadelle, Boulevard du 12ème de Ligne 1, 4000, Liège, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Frédéric Amant
- Biomedical Sciences Group, Department of Oncology, Unit of Gynecological Oncology, KU Leuven, ON4 Herestraat 49, box 1045, 3000, Leuven, Belgium.
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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Chapel DB, Sharma A, Lastra RR, Maccio L, Bragantini E, Zannoni GF, George S, Quade BJ, Parra-Herran C, Nucci MR. A novel morphology-based risk stratification model for stage I uterine leiomyosarcoma: an analysis of 203 cases. Mod Pathol 2022; 35:794-807. [PMID: 35121810 DOI: 10.1038/s41379-022-01011-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/23/2022]
Abstract
Uterine leiomyosarcoma is the most common uterine mesenchymal malignancy. The majority present at stage I, and clinical outcomes vary widely. However, no widely accepted risk stratification system for stage I uterine leiomyosarcoma is currently available. We studied 17 routinely evaluated clinicopathologic parameters in 203 stage I uterine leiomyosarcoma from three institutions to generate a novel risk stratification model for these tumors. Mitoses >25 per 2.4 mm2 (10 high-power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion, and serosal abutment were significantly associated with disease-free and disease-specific survival in univariate and multivariate analyses. These prognostic parameters were each scored as binary ("yes" or "no") variables and fitted to a single optimized algebraic risk model:Risk score = (coagulative necrosis)(1) + (mitoses > 25 per 2.4 mm2)(2) + (atypical mitoses)(2) + (lymphovascular invasion)(3) + (serosal abutment)(5)By logistic regression, the risk model was significantly associated with 5-year disease-free (AUC = 0.9270) and 5-year disease-specific survival (AUC = 0.8517). Internal and external validation substantiated the model. The continuous score (range, 0-13) was optimally divided into 3 risk groups with distinct 5-year disease-free and disease-specific survival: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-13 points) groups. Our novel risk model performed significantly better than alternative uterine leiomyosarcoma risk stratification systems in predicting 5-year disease-free and disease-specific survival in stage I tumors. A simplified risk model, omitting terms for serosal abutment and lymphovascular invasion, can be accurately applied to myomectomy or morcellated specimens. We advocate routine application of this novel risk model in stage I uterine leiomyosarcoma to facilitate patient counseling and proper risk stratification for clinical trials.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Aarti Sharma
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Livia Maccio
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | - Emma Bragantini
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | | | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Li YJ, Lyu J, Li C, He HR, Wang JF, Wang YL, Fang J, Ji J. A novel nomogram for predicting cancer-specific survival in women with uterine sarcoma: a large population-based study. BMC Womens Health 2022; 22:175. [PMID: 35568940 PMCID: PMC9107666 DOI: 10.1186/s12905-022-01739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Uterine sarcoma (US) is a rare malignant uterine tumor with aggressive behavior and rapid progression. The purpose of this study was to constructa comprehensive nomogram to predict cancer-specific survival (CSS) of patients with US-based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods A retrospective population-based study was conducted using data from patients with US between 2010 and 2015 from the SEER database. They were randomly divided into a training cohort and a validation cohort ata 7-to-3 ratio. Multivariate Cox analysis was performed to identify independent prognostic factors. Subsequently, a nomogram was established to predict patient CSS. The discrimination and calibration of the nomogram were evaluated by the concordance index (C-index) and the area under the curve (AUC). Finally, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA) were used to evaluate the benefits of the new prediction model. Results A total of 3861 patients with US were included in our study. As revealed in multivariate Cox analysis, age at diagnosis, race, marital status, insurance record, tumor size, pathology grade, histological type, SEER stage, AJCC stage, surgery status, radiotherapy status, and chemotherapy status were found to be independent prognostic factors. In our nomogram, pathology grade had strongest correlation with CSS, followed by age at diagnosis and surgery status. Compared to the AJCC staging system, the new nomogram showed better predictive discrimination with a higher C-index in the training and validation cohorts (0.796 and 0.767 vs. 0.706 and 0.713, respectively). Furthermore, the AUC value, calibration plotting, NRI, IDI, and DCA also demonstrated better performance than the traditional system. Conclusion Our study validated the first comprehensive nomogram for US, which could provide more accurate and individualized survival predictions for US patients in clinical practice.
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Affiliation(s)
- Yuan-Jie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiao Tong University Health Science Center, Xi'an, Shaanxi, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Chen Li
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hai-Rong He
- Department of Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jin-Feng Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yue-Ling Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jing Fang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jing Ji
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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