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.