Effectiveness of adjuvant treatment for morcellated, International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma: A Korean multicenter study

Aim To evaluate the effectiveness of adjuvant treatment for morcellated, uterus‐confined leiomyosarcoma in a multicenter setting. Methods We identified patients with International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma primarily treated with surgery between 2003 and 2...

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Published in:The journal of obstetrics and gynaecology research 2020-02, Vol.46 (2), p.337-346
Main Authors: Kim, Se Ik, Choi, Chel Hun, Kim, Kidong, Hong, Deok Ho, Park, Jeong‐Yeol, Kwon, Byung Su, Lee, Keun Ho, Hong, Dae Gy, Shin, So‐Jin, Park, Sang‐Il, Kim, Yun Hwan, Lee, Seung‐Ho, Lee, Sanghoon, Hong, Jin Hwa, Lee, Jung‐Yun, Kim, Yong Beom, No, Jae Hong, Suh, Dong Hoon
Format: Article
Language:English
Subjects:
Adjuvant therapy
adjuvant treatment
Chemoradiotherapy
Chemotherapy
Gynecology
leiomyosarcoma
Metastases
Obstetrics
Patients
prognosis
recurrence
Surgery
Survival
Uterine cancer
uterine neoplasms
Uterus
Vagina
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Summary:Aim To evaluate the effectiveness of adjuvant treatment for morcellated, uterus‐confined leiomyosarcoma in a multicenter setting. Methods We identified patients with International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma primarily treated with surgery between 2003 and 2016. Among them, patients who underwent one of the following morcellation methods were included: (i) power morcellation; (ii) intracorporeal morcellation using scalpels or electrocautery; and (iii) vaginal morcellation. Patients' survival outcomes were compared according to the implementation of adjuvant treatment. Results From 13 institutions, 55 patients were included; 31 for adjuvant treatment group and 24 for surgery only group. The clinicopathological characteristics including the mass size, morcellation methods, extent of surgery, and mitotic count were similar between the groups. In the adjuvant treatment group, 67.7%, 19.4% and 12.9% of patients received chemotherapy, chemoradiation and radiation, respectively. After a median follow‐up of 50.5 months, the adjuvant treatment and surgery only groups showed similar overall survival (5‐year rate, 92.0% vs 90.4%; P = 0.959). No significant difference in progression‐free survival was observed between the two groups (3‐year rate, 46.1% vs 78.2%; P = 0.069). On multivariate analyses, adjuvant treatment did not affect progression‐free survival (adjusted HR, 2.138; 95% CI, 0.550–8.305; P = 0.273). The adjuvant treatment group showed a trend towards more common distant metastasis, compared to the surgery only group (25.8% vs 4.2%; P = 0.062). The incidences of pelvic, retroperitoneal, and abdominal recurrences were not different between the groups. Conclusion Despite its frequent use in clinical practice, adjuvant treatment did not improve the survival outcomes of patients with morcellated, International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma.
ISSN:1341-8076
1447-0756
DOI:10.1111/jog.14171