Prognostic Factors and Survival in Patients Treated Surgically for Recurrent Metastatic Uterine Leiomyosarcoma

Background. Uterine leiomyosarcoma (LMS) is a rare diagnosis, which is seldom cured when it recurs with metastatic disease. We evaluated patients who present with first time recurrence treated surgically to determine prognostic factors associated with long-term survival. Methods. Over a 16-year period, 41 patients were operated on for recurrent uterine sarcoma. Data examined included patient age, date of initial diagnosis, tumor histology, grade at the initial diagnosis, cytopathology changes in tumor activity from the initial diagnosis, residual tumor after all operations, use of adjuvant therapy, dates and sites of all recurrences, and disease status at last followup. Results. 24 patients were operated for first recurrence of metastatic uterine LMS. Complete tumor resection with histologic negative margins was achieved in 16 (67%) patients. Overall survival was significantly affected by the FIGO stage at the time of the initial diagnosis, the ability to obtain complete tumor resection at the time of surgery for first time recurrent disease, single tumor recurrence, and recurrence greater than 12 months from the time of the initial diagnosis. Median disease-free survival was 14 months and overall survival was 27 months. Conclusion. Our findings suggest that stage 1 at the time of initial diagnosis, recurrence greater than 12 months, isolated tumor recurrence, and the ability to remove ability to perform complete tumor resection at the time of the first recurrence can afford improved survival in selected patientsat the time of the first recurrence can afford improved survival in selected patients. 1. Introduction Uterine leiomyosarcoma (LMS) is a rare diagnosis and the majority of cases are diagnosed after surgery for uterine fibroid disease. These patients are often observed for long periods of time, and not infrequently percutaneous embolization is utilized in an effort to avoid surgery for large symptomatic fibroid disease. Hysterectomy is usually performed only when the fibroids become excessively symptomatic with pain or bleeding [1]. More recently the potential negative effects of uterine morcellation with fibroid surgery have been described in consideration of this rare entity [2]. The incidence of uterine LMS is unusual and represents about 1% of all uterine malignancies [3, 4], and the vast majority of cases are generally confined to the uterus and cervix at the time of diagnosis [5–7]. Uterine LMS must be distinguished from other mesenchymal tumors, such as endometrial stromal sarcoma, adenosarcoma, carcinosarcoma, epithelial tumors, and