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. 2023 Nov 25:51:101308.
doi: 10.1016/j.gore.2023.101308. eCollection 2024 Feb.

Treatment patterns and outcomes for primary uterine leiomyosarcoma with synchronous isolated lung metastases: A National Cancer Database study of primary resection and metastasectomy

Alexandra C Istl  1 , Nerlyne Desravines  2 , Richard Nudotor  3 , Rebecca Stone  2 , Jonathan B Greer  4 , Christian F Meyer  5 , Fabian M Johnston  4
Affiliations

Treatment patterns and outcomes for primary uterine leiomyosarcoma with synchronous isolated lung metastases: A National Cancer Database study of primary resection and metastasectomy

Alexandra C Istl et al. Gynecol Oncol Rep. .

Abstract

Background: One third of patients with uterine leiomyosarcomas (uLMS) present with distant metastases. Current guidelines do not include recommendations around surgery for metastatic uLMS. Patients with distant metastases commonly receive primary tumor resection for symptoms and so oncologic outcomes after surgery warrant exploration. We describe treatment patterns and outcomes for uLMS patients with synchronous isolated lung metastases (SILM).

Methods: This retrospective analysis of the National Cancer Database identified patients with uLMS and SILM. Patients with non-pulmonary metastases were excluded. We collected demographic, disease, and treatment characteristics and assessed clinicopathologic factors associated with the receipt of surgery on multivariate regression. Median, 1-year, and 5-year overall survival (OS) across treatment approaches were compared using Kaplan-Meier curves and log-rank tests. Multivariate Cox proportional hazard regressions identified independent predictors of survival.

Results: We identified 905 patients with uLMS and SILM between 2004 and 2017. 600 patients had primary tumor resection; 63 also had curative intent surgery with metastasectomy. Patients who did not receive chemotherapy were older (p<0.01) with a higher comorbidity index (p<0.05). Women with private health insurance were more likely to receive chemotherapy (p<0.01) and primary tumor resection (p<0.01). Patients who underwent curative intent surgery had 1-year OS of 71.2% and 5-year survival of 18% compared to 1-year survival of 35.6 % and 5-year survival of 5.16 % for patients who had no surgery. Black women had poorer survival on multivariate regression.

Conclusions: Primary tumor resection and curative intent surgery are associated with improved OS in uLMS with SILM and may be a reasonable treatment option in appropriately selected patients.

Keywords: Leiomyosarcoma; Metastasectomy; National Cancer Database; Primary resection; Pulmonary.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Patterns of management in uLMS with SILM for a. systemic therapy and b. surgical therapy.
Fig. 2
Fig. 2
Median, 1-year, and 5-year OS based on surgical approach and receipt of chemotherapy. Error bars represent positive and negative 95% CI. Value labels represent percentages or months as appropriate.
Fig. 3
Fig. 3
Kaplan-Meier curves for uLMS patients receiving a. chemotherapy, b. hormone therapy, or c. resection of primary tumor or curative intent surgery.
See this image and copyright information in PMC

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