Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Am J Clin Oncol. 2013 Aug;36(4):368-74. doi: 10.1097/COC.0b013e318248dbf4.
Leiomyosarcomas (LMS) comprise 25% of soft tissue sarcomas. Recent reports suggest differences in treatment outcomes between uterine (uLMS) and extrauterine (eLMS) disease that may reflect distinct disease biologies. We sought to identify prognostic factors in LMS and clinicopathologic differences between uLMS and eLMS.
This is a single-center retrospective study evaluating 97 eligible patients treated for LMS between 2002 and 2010.
Median follow-up was 21.2 months. uLMS affected 53% of patients, and was less common beyond age 60 years compared with eLMS (10% vs. 37%, P = 0.002). Seventy-two percent of patients presented with nonmetastatic disease. Of these, 94% underwent curative surgery, among whom more uLMS patients achieved negative surgical margins (90% vs. 45%, P = 0.003). There were no significant differences in adjuvant therapy use and relapse patterns between uLMS and eLMS. Half of metastatic patients received palliative chemotherapy, among whom 76% received anthracycline-based chemotherapy in first line to which response rate was 31%. Median overall survival was 45.2 months, 49.8 months in uLMS, and 40.5 months in eLMS (P = 0.294). Among patients without metastases, median survival was 60.8 months (77.3 vs. 48.1 mo in uLMS and eLMS, respectively, P = 0.194). In metastatic disease, median survival was 20.7 months (22.0 vs. 17.5 mo in uLMS and eLMS, respectively, P = 0.936). Advanced disease stage, bone metastases and lack of metastasectomy prognosticated for inferior survival.
While demonstrating interesting clinicopathologic differences, the evidence for uLMS and eLMS being biologically distinct remains inconclusive. Disease stage is prognostically most important in LMS.
平滑肌肉瘤（LMS）占软组织肉瘤的 25%。最近的报告表明，子宫（uLMS）和子宫外（eLMS）疾病的治疗结果存在差异，这可能反映了不同的疾病生物学特性。我们试图确定 LMS 的预后因素以及 uLMS 和 eLMS 之间的临床病理差异。
这是一项单中心回顾性研究，评估了 2002 年至 2010 年间接受 LMS 治疗的 97 名合格患者。
中位随访时间为 21.2 个月。uLMS 影响了 53%的患者，并且在 60 岁以上的患者中比 eLMS 更为少见（10%对 37%，P=0.002）。72%的患者表现为非转移性疾病。其中，94%的患者接受了根治性手术，uLMS 患者中有更多的患者达到了阴性手术切缘（90%对 45%，P=0.003）。uLMS 和 eLMS 之间在辅助治疗的使用和复发模式方面没有显著差异。一半的转移性患者接受了姑息性化疗，其中 76%的患者在一线治疗中接受了蒽环类药物化疗，反应率为 31%。中位总生存期为 45.2 个月，uLMS 为 49.8 个月，eLMS 为 40.5 个月（P=0.294）。在无转移的患者中，中位生存时间为 60.8 个月（uLMS 和 eLMS 分别为 77.3 和 48.1 个月，P=0.194）。在转移性疾病中，中位生存时间为 20.7 个月（uLMS 和 eLMS 分别为 22.0 和 17.5 个月，P=0.936）。晚期疾病分期、骨转移和缺乏转移瘤切除术与预后不良相关。
虽然显示出有趣的临床病理差异，但子宫平滑肌肉瘤和子宫外平滑肌肉瘤在生物学上存在显著差异的证据仍不明确。疾病分期是 LMS 中最重要的预后因素。
