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Disis ML, Adams SF, Bajpai J, Butler MO, Curiel T, Dodt SA, Doherty L, Emens LA, Friedman CF, Gatti-Mays M, Geller MA, Jazaeri A, John VS, Kurnit KC, Liao JB, Mahdi H, Mills A, Zsiros E, Odunsi K. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gynecologic cancer. J Immunother Cancer 2023; 11:e006624. [PMID: 37295818 PMCID: PMC10277149 DOI: 10.1136/jitc-2022-006624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/12/2023] Open
Abstract
Advanced gynecologic cancers have historically lacked effective treatment options. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration for the treatment of cervical cancer and endometrial cancer, offering durable responses for some patients. In addition, many immunotherapy strategies are under investigation for the treatment of earlier stages of disease or in other gynecologic cancers, such as ovarian cancer and rare gynecologic tumors. While the integration of ICIs into the standard of care has improved outcomes for patients, their use requires a nuanced understanding of biomarker testing, treatment selection, patient selection, response evaluation and surveillance, and patient quality of life considerations, among other topics. To address this need for guidance, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline. The Expert Panel drew on the published literature as well as their own clinical experience to develop evidence- and consensus-based recommendations to provide guidance to cancer care professionals treating patients with gynecologic cancer.
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Affiliation(s)
- Mary L Disis
- Cancer Vaccine Institute, University of Washington, Seattle, Washington, USA
| | - Sarah F Adams
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Jyoti Bajpai
- Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Marcus O Butler
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Tyler Curiel
- Dartmouth-Hitchcock's Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire, USA
| | | | - Laura Doherty
- Program in Women's Oncology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Leisha A Emens
- Department of Medicine, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Claire F Friedman
- 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
| | - Margaret Gatti-Mays
- Pelotonia Institute for Immuno-Oncology, Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Melissa A Geller
- Department of Obstetrics, Gynecology & Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amir Jazaeri
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Veena S John
- Department of Medical Oncology & Hematology, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Katherine C Kurnit
- University of Chicago Medicine Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - John B Liao
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Haider Mahdi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anne Mills
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Emese Zsiros
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Kunle Odunsi
- The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois, USA
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Roser E, Harter P, Zocholl D, Denschlag D, Chekerov R, Wimberger P, Kurzeder C, Hasenburg A, Muallem MZ, Mustea A, Emons G, Zeimet AG, Beck F, Arndt T, Brucker SY, Kommoss S, Heitz F, Welz J, Egger EK, Kalder M, Buderath P, Klar M, Marth C, Ulrich UA, Weigel M, Traub L, Anthuber C, Strauss H, Hanker L, Link T, Kubiak K, Melekian B, Hornung D, Pölcher M, Lampe B, Krauß T, Keilholz U, Flörcken A, Pietzner K, Sehouli J. Treatment strategies in patients with gynecological sarcoma: Results of the prospective intergroup real-world registry for gynecological sarcoma in Germany (REGSA-NOGGO RU1). Int J Gynecol Cancer 2023; 33:223-230. [PMID: 36631151 DOI: 10.1136/ijgc-2022-003800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Gynecological sarcomas account for 3% of all gynecological malignancies and are associated with a poor prognosis. Due to the rarity and heterogeneity of gynecological sarcomas there is still no consensus on optimal therapeutic strategies. This study's objective was to describe the treatment strategies used in patients with gynecological sarcomas in the primary course of disease. METHODS The German prospective registry for gynecological sarcoma (REGSA) is the largest registry for gynecological sarcomas in Germany, Austria and Switzerland. Primary inclusion criteria for REGSA are histological diagnosis of sarcoma of the female genital tract, sarcoma of the breast or uterine smooth muscle tumors of uncertain malignant potential (STUMP). We evaluated data of the REGSA registry on therapeutic strategies used for primary treatment from August 2015 to February 2021. RESULTS A total of 723 patients from 120 centers were included. Data on therapeutic strategies for primary treatment were available in 605 cases. Overall, 580 (95.9%) patients underwent primary surgery, 472 (81.4%) of whom underwent only hysterectomy. Morcellation was reported in 11.4% (n=54) of all hysterectomies. A total of 42.8% (n=202) had no further surgical interventions, whereas an additional salpingo-ophorectomy was performed in 54% (n=255) of patients. An additional lymphadenectomy was performed in 12.7% (n=60), an omentectomy in 9.5% (n=45) and intestinal resection in 6.1% (n=29) of all patients. Among 448 patients with available information, 21.4% (n=96) received chemo- or targeted therapies, more commonly as single-agent treatment than as drug combinations. Information about anti-hormonal treatment was available for 423 patients, among which 42 (9.9%) received anti-hormonal treatment, 23 (54.8%) of whom with low-grade endometrial stroma sarcomas. For radiotherapy, data of 437 patients were available, among which 29 (6.6%) patients underwent radiotherapy. CONCLUSION Our study showed that treatment of patients with gynecologic sarcomas is heterogeneous. Further trials are needed along with more information on treatment modalities, therapy response and patient-reported outcomes to implement new treatment strategies.
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Affiliation(s)
- Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Dario Zocholl
- Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
| | - Radoslav Chekerov
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Pauline Wimberger
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Christian Kurzeder
- Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
| | | | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Guenter Emons
- Department of Gynecology and Obstetrics, University Medicine Goettingen, Goettingen, Germany
| | - A G Zeimet
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Felix Beck
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Tjadina Arndt
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Sara Y Brucker
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Julia Welz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Eva-Katharina Egger
- Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Clinic Gießen and Marburg, Marburg, Germany
| | - Paul Buderath
- Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital Berlin, Berlin, Germany
| | - Michael Weigel
- Department of Obstetrics and Gynecology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Lea Traub
- Department of Obstetrics and Gynecology, Technische Universität Munich, Munich, Germany
| | - Christoph Anthuber
- Department of Obstetrics and Gynecology, Klinikum Starnberg, Starnberg, Germany
| | - Hans Strauss
- Department of Obstetrics and Gynecology, University of Halle (Saale), Halle, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Luebeck, Germany
| | - Theresa Link
- Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Karol Kubiak
- Department of Obstetrics and Gynecology, St. Franziskus Hospital Münster, Muenster, Germany
| | - Badrig Melekian
- Department of Obstetrics and Gynecology, Marienkliniken Siegen, Siegen, Germany
| | - Daniela Hornung
- Department of Obstetrics and Gynecology, Vidiakliniken, Standort Diakonissenkrankenhaus, Karlsruhe, Germany
| | - Martin Pölcher
- Department of Gynecologic Oncology, Rotkreuzklinikum Munich, Munich, Germany
| | - Bjoern Lampe
- Department of Obstetrics and Gynecology, Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Duesseldorf, Germany
| | - Thomas Krauß
- Department of Obstetrics and Gynecology, Klinikum Passau, Passau, Germany
| | - Ulrich Keilholz
- Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Pietzner
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany .,Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
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Putra AD, Maharani N, Gianina K. Ultrasound Features and Diagnostic Workup of Uterine Leiomyosarcomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1837-1844. [PMID: 34726797 DOI: 10.1002/jum.15855] [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: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Uterine leiomyosarcoma is a rare malignancy and is difficult to diagnose preoperatively. In this case series, we retrospectively reassessed ultrasound findings of 18 leiomyosarcoma cases and proposed the diagnostic workup. We are select seven ultrasound features and found irregular tumor border in 100%, loss of normal myometrium >25% in 61.11% (12 cases), loss of typical benign leiomyoma feature >50% in 77.78%, necrosis in 85.7% (16 cases), and cystic degeneration in 83.3% (15 cases). Circumferential vascularity was absent or minimal in 66.7% of cases, whereas intralesional vascularity with minimal or moderate intralesional vascularity was seen in 12 (66.7%) cases. Diagnosis of suspected uterine leiomyosarcoma requires five out of these seven features present, four gray-scale and one color Doppler ultrasound.
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Affiliation(s)
- Andi D Putra
- Gynecologic - Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nastiti Maharani
- Gynecologic - Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kristabella Gianina
- Gynecologic - Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Yoshida H, Kikuchi A, Tsuda H, Sakamoto A, Fukunaga M, Kaku T, Yoshida M, Shikama A, Kogata Y, Terao Y, Tanikawa M, Yasuoka T, Chiyoda T, Miyamoto T, Okadome M, Nakamura T, Enomoto T, Konno Y, Yahata H, Hirata Y, Aoki Y, Tokunaga H, Usui H, Yaegashi N. Discrepancies in pathological diagnosis of endometrial stromal sarcoma: a multi-institutional retrospective study from the Japanese Clinical Oncology Group. Hum Pathol 2022; 124:24-35. [PMID: 35339567 DOI: 10.1016/j.humpath.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022]
Abstract
Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that requires accurate pathological diagnosis for proper treatment. This study aimed to clarify the discrepancies in the pathological diagnosis of ESS and obtain practical clues to improve diagnostic accuracy. Between 2002 and 2015, 148 patients with low-grade ESS (LGESS), high-grade ESS (HGESS), undifferentiated endometrial sarcoma (UES), or undifferentiated uterine sarcoma (UUS) diagnosed at 31 institutions were included. We performed immunohistochemistry, real-time polymerase chain reaction for JAZF1-SUZ12 and YWHAE-NUTM2A/B, and break-apart fluorescent in situ hybridization for JAZF1, PHF1, and YWHAE. Central pathology review (CPR) was performed by six pathologists. After CPR, LGESS, HGESS, UES/UUS, and other diagnoses were confirmed in 72, 25, 16, and 31 cases, respectively. Diagnostic discrepancies were observed in 19.6% (18/92) of LGESS and 34% (18/53) of HGESS or UUS/UES. Adenosarcomas, endometrial carcinomas, carcinosarcomas, and leiomyosarcomas were common diagnostic pitfalls. JAZF1-SUZ12 transcript, PHF1 split signal, and YWHAE-NUTM2A/B transcript were mutually exclusively detected in 23 LGESS, 3 LGESS, and 1 LGESS plus 3 HGESS, respectively. JAZF1-SUZ12 and YWHAE-NUTM2A/B transcripts were detected only in cases with CPR diagnosis of LGESS or HGESS. The CPR diagnosis of LGESS, HGESS, and UUS was a significant prognosticator, and patients with LGESS depicted a favorable prognosis, while those with UUS showed the worst prognosis. Pathological diagnosis of ESS is often challenging and certain tumors should be carefully considered. The accurate pathological diagnosis with the aid of molecular testing is essential for prognostic prediction and treatment selection.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Akira Kikuchi
- Department of Gynecology, Niigata Cancer Center Hospital, 2-15-3, Chuo-ku, Kawagishicho Niigata, 951-8566, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
| | - Atsuhiko Sakamoto
- Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, Tokyo, 143-8527, Japan
| | - Masaharu Fukunaga
- Department of Pathology, Shin-Yurigaoka General Hospital, kawasaki, Kanagawa, 215-0026, Japan
| | - Tsunehisa Kaku
- Center for Preventive Medicine, Fukuoka Sanno Hospital, Fukuoka, 814-0001, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Ayumi Shikama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 569-8686, Japan
| | - Yuhei Kogata
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Tsukuba, Osaka, 569-8686, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, 113-8431, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Toshiaki Yasuoka
- Department of Obstetrics and Gynecology, Ehime University, Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-0016, Japan
| | - Tsutomu Miyamoto
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, 390-8621, Japan
| | - Masao Okadome
- Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Toshiaki Nakamura
- Department of Obstetrics and Gynecology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, 890-8760, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8510, Japan
| | - Yosuke Konno
- Department of Gynecology, Hokkaido University Hospital, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yukihiro Hirata
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Uehara Nishihara, Okinawa, 903-0125 207, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8670, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8575, Japan
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Condic M, Egger EK, Hohenberger P, Staerk C, Mayr A, Armbrust R, Roser E, Mustea A, Sehouli J. Clinical value of pre-operative scoring systems to predict leiomyosarcoma: results of a validation study in 177 patients from the NOGGO-REGSA Registry. Int J Gynecol Cancer 2022; 32:619-625. [DOI: 10.1136/ijgc-2021-003334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
ObjectivesBenign leiomyomas are the most common uterine tumors. In contrast, uterine leiomyosarcomas are malignancies with a poor prognosis due to difficulties in early diagnosis and inappropriate surgical treatment. Most often they are diagnosed incidentally after surgery performed for treatment of leiomyoma. As the appropriate surgical treatment is crucial for survival of the patient, there is a high demand to predict leiomyosarcoma pre-operatively. Available scoring systems to discriminate leiomyoma from leiomyosarcoma are based on retrospective studies with limited numbers of patients and are not implemented in routine clinical practice.MethodsThe aim of our study was to evaluate a recently published score—the pre-operative leiomyosarcoma (pLMS) score—to determine whether it would have been predictive of leiomyosarcoma in 177 patients from the NOGGO-REGSA study, a German register of histologically proven gynecological sarcoma detected during routine clinical investigation.ResultsThe threshold of the pLMS score for ‘leiomyosarcoma not probable’ (< −3) failed for 7.5% of the patients and the threshold ‘indicator for leiomyosarcoma’ (>+1) was true for 39.1% of the patients. 53.4% of the patients were attributed to the group ‘additional investigations are recommended’ (−3 to +1). The most relevant parameters in our analysis were suspicious sonography and rapid growth, but neither have been quantitatively defined.ConclusionIn our validation cohort, the pLMS score seems not to be a reliable tool to predict leiomyosarcoma and therefore we do not recommend its clinical implementation to identify leiomyosarcoma.
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Brudner Y, Salman L, Haran G, Blecher A, Hallak M, Bruchim I. High incidence of gynecologic sarcomas in Israel-A comparison to European and American reports: Gynecologic Sarcoma in Israel. Maturitas 2021; 154:1-6. [PMID: 34736574 DOI: 10.1016/j.maturitas.2021.09.001] [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: 04/19/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Gynecologic Sarcomas are rare, aggressive tumors. The aim of this study was to explore the incidence and outcomes of gynecologic sarcomas in a large national data registry and to compare them with reports from other countries. STUDY DESIGN Records of gynecologic sarcomas diagnosed in Israel (1980-2014) were extracted from the National Cancer Registry and classified according to International Classification of Diseases for Oncology-3 and characterized according to anatomical site, morphology and demographics. Age-standardized incidence rates and 1, 3, 5 and 10-year relative survival rates were calculated for 3 time periods (1980-1994, 1995-2001 and 2005-2014) according to patient age, stage and years of diagnosis. RESULTS During 1980-2014, 1271 new gynecologic sarcomas were diagnosed in Israel, with incidence slightly increasing in 1980-2004, to an age-standardized incidence rate of 13 per million women. The most common histologic diagnosis was leiomyosarcoma (48%) and the most common anatomical site was the uterus (89%). The age-standardized incidence rate for uterine sarcoma is higher in Israel (10.55 per million) than in England (7.4 per million) and Germany (5.8 per million) respectively. The 5-year overall survival was significantly poorer in patients >70-years, as compared to younger patients (p<0.001) and in those with leiomyosarcoma compared to endometrial stromal sarcoma (p<0.001). The survival rate of patients with leiomyosarcoma in Israel are comparable to survival rates reported by other studies, although substantially lower regarding endometrial stromal sarcoma. CONCLUSIONS Uterine leiomyosarcoma was the most common gynecologic sarcoma found in the Israeli, European and American registries. Older patients and those with leiomyosarcoma have the worst prognoses. Histological and anatomical variations in Israel are comparable with global statistics, but the incidence in Israel seems higher than in Europe.
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Affiliation(s)
- Yana Brudner
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Lina Salman
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel.
| | - Gabi Haran
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Anna Blecher
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Mordechai Hallak
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Ilan Bruchim
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
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7
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Burdett N, Bae S, Hamilton A, Desai J. The Role of Systemic Therapies in the Management of Soft Tissue Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Akbari A, Khalili N, Asef-Kabiri L, Negahi A, Raeisi A, Akbari ME. Incidence patterns of gynecological sarcomas in Iran analysis of National Cancer Registry data between 2009 and 2014. J Obstet Gynaecol Res 2020; 46:2672-2678. [PMID: 33029884 DOI: 10.1111/jog.14514] [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: 04/10/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 11/28/2022]
Abstract
AIM Gynecological sarcomas (GS) are rare malignant tumors arising in the female genital organs. Due to the low incidence and diverse histology, information on the epidemiology of these tumors is sparse. We aimed to investigate the incidence rates of GS in Iran that in our knowledge is the first report from Eastern Mediterranean Region. METHODS In this retrospective study, all malignant tumors with a sarcoma morphology arising in the female genital organs diagnosed between 2009 and 2014 were extracted from the Iran National Cancer Registry dataset. All the cancer cases were categorized according to ICD-O-3 morphologic and topographic codes. Age-standardized incidence rates, age-specific incidence rates, morphologic and geographic distribution of all cases were analyzed and compared with other parts of the world. RESULTS A total of 1174 cases were diagnosed over the period 2009-2014. The overall age-standardized incidence rate for all sites combined was 6.13 per million females. Analysis of trends in incidence did not show a significant change over time according to annual average percent change analysis (P-value = 0.300). The most common anatomical site was the uterus, accounting for 77% of all cases. The mean (±SD) age at diagnosis, irrespective of tumor site, was 52.3 (±15) years. In terms of morphology, leiomyosarcoma was the most frequently observed subtype, constituting 34% of all GS. Also, the highest ASIR was observed in women aged 60-64 years. CONCLUSION Based on the findings, GS are relatively rare tumors that occur more in old women. The results of this study provide a comprehensive picture of GS incidence patterns in Iran for more investigation.
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Affiliation(s)
- Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Khalili
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Asef-Kabiri
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Surgery, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Negahi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Raeisi
- Internal Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad E Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Plentz TBDSF, Candido EC, Dias LF, Toledo MCS, Vale DB, Teixeira JC. Diagnosis, treatment and survival of uterine sarcoma: A retrospective cohort study of 122 cases. Mol Clin Oncol 2020; 13:81. [PMID: 33093955 DOI: 10.3892/mco.2020.2151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to assess the diagnosis, treatment and follow-up of uterine sarcoma cases. A retrospective cohort study with 122 women recruited between 2001 and 2016 was performed. The data regarding epidemiology, clinical presentation, treatment and follow-up were analyzed based on the following histological types: Carcinosarcoma, leiomyosarcoma, endometrial stromal sarcoma (ESS) and adenosarcoma. Statistical analysis included descriptive statistics, logistic regression and survival curves. The diagnosis of uterine sarcoma exhibited an increasing trend of +1.2 new cases every 2 years (P=0.044) and comprised 10% of all uterine cancer diagnoses. There were 47% carcinosarcomas, 22% leiomyosarcomas, 16% ESS and 14% adenosarcomas. The majority of the women was ≥60 years old (62%). Among the subjects, 77% were postmenopausal, 61% had a body mass index up to 29.9 kg/m2 and 71% presented with a comorbidity. Regression analysis exhibited an association between post menopause and the histological type associated with lower overall survival (OS), namely leiomyosarcoma or carcinosarcoma (odds ratio, 5.45, P<0.001). Stage I malignancy was present in 44% and Stage IV in 22%. The treatment included primary surgery in 78% of the cases, whereas 79% received adjuvant therapy. Only 55 cases achieved disease control and 20 relapsed (36%) with a 5-year OS rate of 33%. The OS was lower for carcinosarcoma and leiomyosarcoma (20%; P=0.003). In summary, the present study indicated that the number of uterine sarcoma cases had increased between 2001 and 2016. The majority of the women were >60 years old and diagnosed in advanced stages. The postmenopausal status was associated with histological types of poor prognosis. The OS was low and worse for patients with carcinosarcoma and leiomyosarcoma.
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Affiliation(s)
| | - Elaine Cristina Candido
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Lais Flausino Dias
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | | | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
| | - Julio Cesar Teixeira
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, 13083-881 São Paulo, Brazil
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Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019; 100:619-634. [PMID: 31427216 DOI: 10.1016/j.diii.2019.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
Uterine leiomyomas, the most frequent benign myomatous tumors of the uterus, often cannot be distinguished from malignant uterine leiomyosarcomas using clinical criteria. Furthermore, imaging differentiation between both entities is frequently challenging due to their potential overlapping features. Because a suspected leiomyoma is often managed conservatively or with minimally invasive treatments, the misdiagnosis of leiomyosarcoma for a benign leiomyoma could potentially result in significant treatment delays, therefore increasing morbidity and mortality. In this review, we provide an overview of the differences between leiomyoma and leiomyosarcoma, mainly focusing on imaging characteristics, but also briefly touching upon their demographic, histopathological and clinical differences. The main indications and limitations of available cross-sectional imaging techniques are discussed, including ultrasound, computed tomography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography. A particular emphasis is placed on the review of specific MRI features that may allow distinction between leiomyomas and leiomyosarcomas according to the most recent evidence in the literature. The potential contribution of texture analysis is also discussed. In order to help guide-imaging diagnosis, we provide an MRI-based diagnostic algorithm which takes into account morphological and functional features, both individually and in combination, in an attempt to optimize radiologic differentiation of leiomyomas from leiomyosarcomas.
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Affiliation(s)
- S Sun
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada.
| | - P A Bonaffini
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - S Nougaret
- Inserm, U1194, Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 34295 Montpellier, France
| | - L Fournier
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - A Dohan
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Radiology A, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - J Chong
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
| | - J Smith
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - H Addley
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, CB2 0QQ Cambridge, United Kingdom
| | - C Reinhold
- Department of Radiology, McGill University Health Centre, 1001 Decarie boulevard, H4A 3J1 Montreal, QC, Canada
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Preliminary utilization of radiomics in differentiating uterine sarcoma from atypical leiomyoma: Comparison on diagnostic efficacy of MRI features and radiomic features. Eur J Radiol 2019; 115:39-45. [PMID: 31084757 DOI: 10.1016/j.ejrad.2019.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To explore whether MRI and radiomic features can differentiate uterine sarcoma from atypical leiomyoma. And to compare diagnostic performance of radiomic model with radiologists. METHODS 78 patients (29 sarcomas, 49 leiomyomas) imaged with pelvic MRI prior to surgery were included in this retrospective study. Certain clinical and MRI features were evaluated for one lesion per patient. Radiological diagnosis was made based on MRI features. A radiomic model using automated texture analysis based on ADC maps was built to predict pathological results. The association between MRI features and pathological results was determined by multivariable logistic regression after controlling for other variables in univariate analyses with P < 0.05. The diagnostic efficacy of radiologists and radiomic model were compared by area under the receiver-operating characteristic curve (AUC), sensitivity, specificity and accuracy. RESULTS In univariate analyses, patient's age, menopausal state, intratumor hemorrhage, tumor margin and uterine endometrial cavity were associated with pathological results, P < 0.05. Patient's age, tumor margin and uterine endometrial cavity remained significant in a multivariable model, P < 0.05. Diagnosis efficacy of radiologists based on MRI reached an AUC of 0.752, sensitivity of 58.6%, specificity of 91.8%, and accuracy of 79.5%. The optimal radiomic model reached an AUC of 0.830, sensitivity of 76.0%, average specificity of 73.2%, and accuracy of 73.9%. CONCLUSIONS Ill-defined tumor margin and interrupted uterine endometrial cavity of older women were predictors of uterine sarcoma. Radiomic analysis was feasible. Optimal radiomic model showed comparable diagnostic efficacy with experienced radiologists.
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Xie H, Zhang X, Ma S, Liu Y, Wang X. Preoperative Differentiation of Uterine Sarcoma from Leiomyoma: Comparison of Three Models Based on Different Segmentation Volumes Using Radiomics. Mol Imaging Biol 2019; 21:1157-1164. [DOI: 10.1007/s11307-019-01332-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Nishigaya Y, Kobayashi Y, Matsuzawa Y, Hasegawa K, Fukasawa I, Watanabe Y, Tokunaga H, Yaegashi N, Iwashita M. Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma. J Obstet Gynaecol Res 2018; 45:189-194. [PMID: 30152048 DOI: 10.1111/jog.13792] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/28/2018] [Indexed: 12/16/2022]
Abstract
AIM Leiomyosarcoma is the most common type of uterine sarcoma. In some leiomyosarcoma cases, preoperative diagnosis might be difficult, and they might be treated as benign lesions. We evaluated diagnostic values of preoperative serum lactate dehydrogenase (LDH), D-dimer and C-reactive protein for differentiating leiomyosarcoma. METHODS From 2008 to 2013, leiomyosarcoma cases in three university hospitals were enrolled. Preoperative serum LDH, D-dimer and C-reactive protein were analyzed if tested. These markers of pathologically diagnosed leiomyoma cases presumed benign (group B) and presumed malignant (group PM) were compared with those of leiomyosarcoma cases (group S). RESULTS Groups S, PM and B had 36, 28 and 69 cases, respectively. Positive rates of LDH were 66.7%, 14.3% and 0% in groups S, PM and B, respectively. Positive rates of D-dimer and C-reactive protein were 83.3% and 64.5%, 17.9% and 10.7% and 5% and 2.9% in groups S, PM and B, respectively. Positive rates of all three markers were high in the order of leiomyosarcoma, atypical leiomyoma and typical leiomyoma. In group PM, 12 (63.2%) cases were negative for all three markers, whereas 1 (3.3%) case was negative in group S. No case was positive for all markers in group PM, whereas 41.2% leiomyosarcoma cases were positive for all markers. When all parameters were positive, specificity and positive predictive value were 100% in differentiating leiomyosarcoma from group PM. CONCLUSION Combination of LDH, D-dimer and C-reactive protein could be useful for distinguishing leiomyosarcoma from especially degenerated or atypical leiomyoma.
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Affiliation(s)
- Yoshiko Nishigaya
- Department of Obstetrics and Gynecology, Kyorin University, School of Medicine, Mitaka, Japan
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University, School of Medicine, Mitaka, Japan
| | - Yukiko Matsuzawa
- Department of Obstetrics and Gynecology, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kiyoshi Hasegawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
| | - Ichio Fukasawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University, School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, School of Medicine, Sendai, Japan
| | - Mitsutoshi Iwashita
- Department of Obstetrics and Gynecology, Kyorin University, School of Medicine, Mitaka, Japan
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