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Yorgancı A, Meydanlı MM, Kadıoğlu N, Taşkın S, Kayıkçıoğlu F, Altın D, Atasoy L, Haberal AN, Kınay T, Akgül MA, Tapısız ÖL, Evliyaoğlu Ö, Tekin ÖM, Fırat Ortaç U, Ayhan A. Incidence and outcome of occult uterine sarcoma: A multi-centre study of 18604 operations performed for presumed uterine leiomyoma. J Gynecol Obstet Hum Reprod 2019; 49:101631. [PMID: 31499285 DOI: 10.1016/j.jogoh.2019.101631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/02/2019] [Accepted: 09/05/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Ayçağ Yorgancı
- Department of Gynaecology, Ankara Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health, Sciences, Ankara, Turkey.
| | - Mehmet Mutlu Meydanlı
- Department of Gynaecology, Ankara Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health, Sciences, Ankara, Turkey.
| | - Nezaket Kadıoğlu
- Department of Gynaecology, Ankara Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health, Sciences, Ankara, Turkey.
| | - Salih Taşkın
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, School of Medicine, Ankara University, Ankara, Turkey.
| | - Fulya Kayıkçıoğlu
- Department of Gynaecology, Etlik Zübeyde Hanım Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Duygu Altın
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, School of Medicine, Ankara University, Ankara, Turkey.
| | - Latife Atasoy
- Department of Obstetrics and Gynaecology, School of Medicine, Başkent University, Ankara, Turkey.
| | - Asuman Nihan Haberal
- Department of Pathology, School of Medicine, Başkent University, Ankara, Turkey.
| | - Tuğba Kınay
- Department of Gynaecology, Etlik Zübeyde Hanım Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Mehmet Akif Akgül
- Department of Gynaecology, Etlik Zübeyde Hanım Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Ömer Lütfi Tapısız
- Department of Gynaecology, Etlik Zübeyde Hanım Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Özlem Evliyaoğlu
- Department of Gynaecology, Ankara Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, University of Health, Sciences, Ankara, Turkey.
| | - Özlem Moraloğlu Tekin
- Department of Gynaecology, Etlik Zübeyde Hanım Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - U Fırat Ortaç
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, School of Medicine, Ankara University, Ankara, Turkey.
| | - Ali Ayhan
- Department of Obstetrics and Gynaecology, School of Medicine, Başkent University, Ankara, Turkey.
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Nesrine T, Ines Z, Abdelwahed N, Ali AM, Nadia B, Monia H, Hatem B, Maher S, Khaled R. Prognostic factors and the role of pelvic lymphadenectomy in uterine leiomyosarcomas. SAGE Open Med 2019; 7:2050312119856817. [PMID: 31236276 PMCID: PMC6572874 DOI: 10.1177/2050312119856817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/19/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives: Leiomyosarcomas are relatively rare uterine smooth muscle tumors. Surgery is the most common therapy choice for uterine leiomyosarcomas. However, controversy exists over the appropriate initial surgical management, especially about the role of lymph node sampling. The aim of our study is to analyze the prognostic factors and the role of lymphadenectomy in overall survival and in disease-free survival. Methods: We analyzed retrospectively 31 patients suffering from uterine leiomyosarcomas at Institute of Salah Azaiez during 2000–2014. Demographic and clinical features such as age, menopausal status, stage, tumor size, and management options were examined, and pathological characteristics such as mitotic count, lymphovascular space invasion, and tumor necrosis were evaluated. Results: Out of 31 patients treated for uterine leiomyosarcomas, pelvic lymphadenectomy was done for 18 patients. No para-aortic lymphadenectomy was performed. Median number of resected lymph nodes was 13 ± 7 (range: 3–27). Lymphatic metastasis was observed in 2 out of 18 patients with clinical stage IA and IIIB. The distribution of different variables (age, International Federation of Gynecology and Obstetrics stage, tumor size, mitotic count, and adjuvant treatment) between the group of patients, who had or had not lymphadenectomy done, had no significant difference. The 5-year overall survival and disease-free survival were 61% and 50%, respectively. Clinical stage, presence of lymphovascular space invasion, and lymph nodal dissection were found to be relevant for disease-free survival on univariate analysis. Only age and menopausal status were found to be a prognostic factor for overall survival. Conclusion: Hence, routine lymph node dissection was not generally recommended. Our study demonstrates that lymphadenectomy has a statistically significant effect on disease-free survival but not on overall survival.
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Affiliation(s)
- Tounsi Nesrine
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Zemni Ines
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Nawel Abdelwahed
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Ayadi Mohamed Ali
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | | | - Hechiche Monia
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Bouzaine Hatem
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Slimane Maher
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
| | - Rahel Khaled
- Department of Surgical Oncologists, Salah Azaiez Institute, Tunis, Tunisia
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Abstract
INTRODUCTION The role of lymphadenectomy in the management of uterine leiomyosarcoma (LMS) is controversial. We aimed to identify whether lymph node dissection (LND) has any survival benefit in uterine LMS. METHODS Data of 95 patients with histologically proven uterine LMS from 2 tertiary centers (1993 through 2009) were retrospectively analyzed. Kaplan-Meier and Cox proportional hazards regression models were used for analyses. RESULTS Mean age was 51.5 years. Thirty-six (37.9%) underwent LND. The median lymph node count was 54. Eight (22.2%) patients had lymphatic metastasis. Median follow-up was 26 months. Sixty-two (65%) patients had recurrence and 48 (50.5%) died. Median disease-free survival (DFS) was 19 months for both group of patients who had or did not have LND, and median overall survival (OS) was 29 and 26 months, respectively (P = 0.4). Five-year DFS was 35.9% vs 26.8% (P = 0.4), and 5-year OS was 45.4% vs 43.8% (P = 0.22) for the groups. Multivariate analyses did not reveal a single independent prognostic factor in respect to DFS or OS. CONCLUSION Higher rate of lymph node metastasis in patients with extrauterine disease indicated the importance of LND in LMS. However, the survival benefit of lymphadenectomy could not be shown.
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