Ovarian conservation without postoperative radiation improved survival outcomes in patients with stage i uterine leiomyosarcoma

Introduction: Little observational data exists regarding the efficacy of different treatment modalities on the survival outcome of patients with uterine leiomyosarcoma. Objective and Design: This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results database to identify surgery-based treated patients with uterine leiomyosarcoma diagnosed between 1982 to 2015 (N = 4289). The associations between survival outcomes and treatment modalities regarding postoperative radiation and ovarian conservation were assessed. Results: A total of 1104 patients were included in the study, 19.02% (210/1104) patients received postoperative radiation, 11.59% (128/110) patients received ovarian conservation. The median follow-up duration was 37.27 ± 34.69 months (95%CI: 35.39-39.38 months). After propensity score matching, there were no variable differences among compared groups. For FIGO stage I-II patients, postoperative radiation did not improve five-year-overall survival (49.1 vs. 47.1%, p = 0.818) and five-year-cause-specific survival (51.5 vs. 49.9%, p = 0.910). For International Federation of Gynecology and Obstetrics stage I patients who were younger than 50 years old, five-year-overall survival (75.4 vs. 60.3%, p = 0.053) and five-year-cause-specific survival (75.4 vs. 65.1%, p = 0.146) were similar between women underwent ovarian conservation and those who did not. However, after excluding patients who received radiotherapy, patients showed a better survival outcome than control group (five-year-overall survival: 76.3 vs. 54.0%, p = 0.031; five-year-cause-specific survival: 76.30 vs. 55.3%, p = 0.046). Conclusions: In women with stage I-II uterine leiomyosarcoma, postoperative radiation did not improve five-year-overall-survival and five-year-cause-specific survival. In young women with stage I uterine leiomyosarcoma who didn’t receive postoperative radiotherapy, ovarian conservation was associated with increased overall survival and cause-specific survival.

Uterine leiomyosarcoma; Ovarian conservation; Postoperative radiation; Propensity score matching

[1] Trope C.G., Abeler V.M., Kristensen G.B.: “Diagnosis and treatment of sarcoma of the uterus. A review”. Acta. Oncol., 2012, 51, 694.

[2] American Cancer Society: “Cancer Facts and Figures 2017”. Available at: https://www.cancer.org /content/dam/cancer- org/research/cancer-facts-and-statistics/annual-cancer-facts-and- figures/2017/cancer-facts-and-figures-2017.pdf.

[3] NCCN Clinical Practice Guidelines in Oncology: “Uterine Neoplasms. Version 2 .2018 2018”. Available at: www.nccn.org.

[4] Reed N.S., Mangioni C., Malmström H., Scarfone G., Poveda A., Pecorelli S., et al.: “European Organization for Research and Treatment of Cancer Gynaecological Cancer Group. Phase III randomized study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874)”. Eur. J. Cancer, 2008, 44, 808.

[5] Sampath S., Schultheiss T.E., Ryu J.K., Wong J.Y.: “The role of adjuvant radiation in uterine sarcomas”. Int. J. Radiat. Oncol. Biol.Phys., 2010, 76, 728.

[6] Mahdavi A., Monk B.J., Ragazzo J., Hunter M.I., Lentz S.E., Vasilev S.A., et al.: “Pelvic radiation improves local control after hysterectomy for uterine leiomyosarcoma: a 20-year experience”. Int. J. Gynecol. Cancer, 2009, 19, 1080.

[7] Giuntoli R.L., Metzinger D.S., DiMarco C.S., Cha S.S., Sloan J.A., Keeney G.L., et al.: “Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy”. Gynecol. Oncol., 2003, 89, 460.

[8] Dusenbery K.E., Potish R.A., Judson P.: “Limitations of adjuvant radiotherapy for uterine sarcomas spread beyond the uterus”. Gynecol. Oncol., 2004, 94, 191.

[9] Group EESNW: “Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”. Ann. Oncol., 2012, 23, 92.

[10] Kapp D.S., Shin J.Y., Chan J.K.: “Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy”. Cancer, 2008, 112, 820.

[11] Zivanovic O., Leitao M.M., Iasonos A., Jacks L.M., Zhou Q., Abu-Rustum N.R., et al.: “Stage-specific outcomes of patients with uterine leiomyosarcoma: a comparison of the international Federation of gynecology and obstetrics and American joint committee on cancer staging systems”. J. Clin. Oncol., 2009, 27, 2066.

[12] Prat J.: “FIGO staging for uterine sarcomas”. Int. J. Gynaecol. Obstet., 2009, 104, 177.

[13] National Cancer Institute Surveillance, Epidemiology, and End Results Program: “Cancer statistics”. Available at: http://seer.cancer.gov/.

[14] Kaunitz A.M., Manson J.E.: “Management of menopausal symptoms”. Obstet. Gynecol., 2015, 126, 859.

[15] Wu T.I., Chang T.C., Hsueh S., Hsu K.H., Chou H.H., Huang H.J., Lai C.H.: “Prognostic factors and impact of adjuvant chemotherapy for uterine leiomyosarcoma”. Gynecol. Oncol., 2006, 100, 166.

[16] Berchuck A., Rubin S.C., Hoskins W.J., Saigo P.E., Pierce V.K., Lewis J.L. Jr.: “Treatment of uterine leiomyosarcoma”. Obstet. Gynecol., 1988, 71, 845.

[17] Larson B., Silfverswärd C., Nilsson B., Pettersson F.: “Prognostic factors in uterine leiomyosarcoma. A clinical and histopathological study of 143 cases. The Radiumhemmet series 1936–1981”. Acta Oncol., 1990, 29, 185.

[18] Leitao M.M., Sonoda Y., Brennan M.F., Barakat R.R., Chi D.S.: “Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus”. Gynecol. Oncol., 2003, 91, 209.

[19] Nasioudis D., Chapman-Davis E., Frey M., Holcomb K.: “Safety of ovarian preservation in premenopausal women with stage I uterine sarcoma”. J. Gynecol. Oncol., 2017, 28, 46.