Shoushtari A N, Landa J, Kuk D, Sanchez A, Lala B, Schmidt N, Okoli C, Chi P, Dickson M A, Gounder M M, Keohan M L, Crago A M, Tap W D, D'Angelo S P
Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Sarcoma. 2016;2016:3547497. doi: 10.1155/2016/3547497. Epub 2016 May 29.
Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy. Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) in N = 113 was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26-0.79, p = 0.005). Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.
背景。平滑肌肉瘤（LMS）是软组织肉瘤中的一个异质性亚组。影响转移性子宫外平滑肌肉瘤（euLMS）患者预后的因素尚未得到充分描述。关于全身治疗反应的数据有限。方法。我们收集了1989年至2012年间在纪念斯隆凯特琳癌症中心就诊的所有转移性euLMS患者的临床和病理信息。使用RECIST 1.1对一部分有可用基线和治疗期间影像学资料的患者的一线治疗客观反应进行了分析。结果。215例转移性euLMS患者自转移时起的中位总生存期（OS）为2.6年。多因素分析显示，年龄较大、男性以及转移初始部位≥3个与较差的OS相关。在N = 113例患者中，总体客观缓解率（ORR）为19%，吉西他滨、吉西他滨加多西他赛以及蒽环类-烷化剂联合方案的客观缓解率分别为25%、26%和25%。肿瘤对一线治疗有客观反应的患者与无反应者相比死亡风险较低（风险比0.46；95%置信区间：0.26 - 0.79，p = 0.005）。结论。基于蒽环类和吉西他滨的方案在这组euLMS患者中具有相似的活性。OS的预后因素包括年龄较大、男性以及转移初始部位≥3个。
