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Meta-Analysis
. 2022 Apr 18;20(1):124.
doi: 10.1186/s12957-022-02584-4.

Leiomyosarcoma in the extremities and trunk wall: systematic review and meta-analysis of the oncological outcomes

Sudhir Kannan  1   2   3 , Han Hong Chong  4 , Bryan Chew  4 , Jay Dee Ferguson  5 , Euan Galloway  6 , Thomas McCulloch  6 , Kenneth S Rankin  7   5 , Robert U Ashford  4   6
Affiliations
Meta-Analysis

Leiomyosarcoma in the extremities and trunk wall: systematic review and meta-analysis of the oncological outcomes

Sudhir Kannan et al. World J Surg Oncol. .

Abstract

Background: Leiomyosarcomas are aggressive malignancies which can occur on the trunk and extremities whose pathogenesis is poorly understood. We aim to quantify the prognostic impact of various clinical and pathological markers on survival and recurrence of leiomyosarcomas.

Methods: We conducted a systematic review as per PRISMA protocol. Survival, local recurrence, and metastasis were the outcome measures. Data were extracted from the studies for the outcome variables; the resultant odds ratios (OR) and 95% confidence interval (CI) were used for the synthesis of a forest plot.

Results: Our search revealed thirteen studies comprising 1380 patients. Seven of these 13 publications were since 2012. Our analysis showed that tumor size larger than 5 cm adversely affected the outcome with an OR 3.39 (2.26-5.10, p < 0.01). Other factors which reduced the overall survival were positive margins of excision OR 2.12 (1.36-3.32, p < 0.01). A reduced risk of metastasis has strongly associated the use of radiotherapy with OR 10.84 (4.41-26.61, p < 0.01). Only a few studies analyzed the impact of factors on local recurrence.

Conclusions: Size larger than 5 cm and positive margins of excision are associated with poor overall survival. In comparison, the use of adjuvant radiotherapy was associated with a lower metastatic rate. There is a need for methodically high-quality studies with more uniform study design and reporting to evaluate the impact of various risk factors on local recurrence and metastases.

Level of evidence: Level 1 Prognostic.

Keywords: Extremities; Leiomyosarcoma; Outcomes; Soft tissue; Trunk wall.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart studies selection. LMS, leiomyosarcoma
Fig. 2
Fig. 2
Forest plot showing the odd ratio of survival rate in leiomyosarcoma in relation to risk factors of a age, b size of tumor, c excision margin, d tumor grade, and e adjuvant radiotherapy. SE, standard error; CI, confidence interval; I2, level of heterogeneity; RT, radiotherapy
Fig. 3
Fig. 3
Forest plot showing the odd ratio of distant metastasis in leiomyosarcoma in relation to risk factors of a size of tumor, b location, c adjuvant chemotherapy, and d adjuvant radiotherapy. SE, standard error; CI, confidence interval; I2, level of heterogeneity; RT, radiotherapy
Fig. 4
Fig. 4
Funnel plot for publication bias assessment. a Age vs survival rate, b size vs survival rate, c excision margin vs survival rate, d tumor grade vs survival rate, e adjuvant radiotherapy vs survival rate, f size of tumor vs distant metastasis, g location vs distant metastasis, h adjuvant chemotherapy vs distant metastasis, and i adjuvant radiotherapy vs distant metastasis
See this image and copyright information in PMC

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