INTRODUCTION
Uterine sarcomas account for approximately 3%-7% of all uterine
cancers.(Mbatani et al , 2018) The most common histologic types of
uterine sarcomas are leiomyosarcomas (LMS, 63%), endometrial stromal
sarcomas (ESS, 21%), adenosarcomas (6%), undifferentiated sarcoma
(5%), and smooth muscle tumors of uncertain malignant potential
(STUMP).(Kurman RJ, Carcanigiu ML, Herrington S, Young RH.) Most women
with uterine leiomyosarcoma (uLMS) are diagnosed in their 50s and the
vast majority present with disease confined to the uterine.(Kappet al , 2008) Preoperative diagnosis of leiomyosarcoma is
difficult and often only made at time of surgical resection. Uterine
leiomyosarcoma is an aggressive malignant tumor with a high rate of
recurrence.(Takehara et al , 2020) Though the majority (60%) are
diagnosed at an early stage, uLMS is still associated with a poor
prognosis. (Roberts et al , 2018)The 5-year overall survival rates
for stage I, II, III, and IV uLMS were 55.4%, 32.6%, 24.6%, and
13.1%, respectively.(Seagle et al , 2017) Recurrence rate has
been reported to be 45-73% in uLMS.(Giuntoli et al , 2007) Time
to first recurrence varies widely and the median intervals are estimated
around 12–24 months.(Bartosch et al , 2017) The disease of most
patients recurs within the pelvis and upper abdominal. And metastasis to
the lungs is also common.
Very few patients with recurrent or metastatic uLMS can be curatively
treated. The prognosis of patients with recurrent/persistent uLMS is
poor and the 5-year post-relapse survival rate was 15%.(Rauh-Hainet al , 2014) Due to their rarity, the management strategy for
patients with recurrent uLMS has not been well established. Treatment
choice for recurrent disease is dependent on previous therapy, the site
of the recurrent tumor, time to recurrence, and the patient’s
performance status.(Rauh-Hain et al , 2014)
These tumors are relatively chemo and/or radio-resistant. Optimal
surgical resection for recurrent uLMS may provide an opportunity for
long-term survival in a select patient population.(Leitao et al ,
2002) Patients presenting after a prolonged progression-free interval
with an isolated site of recurrence amenable to complete resection are
the best candidates for attempted surgical resection.(Giuntoli et
al , 2007) Secondary cytoreduction to no residual disease is an option
that may be proposed in recurrent uterine leiomyosarcoma.(Bizzarriet al , 2019) Modern multimodal therapy or combining chemotherapy
with aggressive surgery in selected patients may be significant in
prolonging survival of women with this fatal disease.(Bernstein-Molhoet al , 2010)
We therefore conducted a
retrospective cohort study to evaluate the clinical characteristics and
treatment outcomes of women with recurrent uterine leiomyosarcoma and
identify prognostic factors.