Fucà Giovanni, Fabbroni Chiara, Mancari Rosanna, Manglaviti Sara, Bogani Giorgio, Fumagalli Elena, Bertulli Rossella, Morosi Carlo, Collini Paola, Raspagliesi Francesco, Colombo Nicoletta, Casali Paolo G, Sanfilippo Roberta
Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy.
Program of Gynecologic Oncology, IEO, Istituto Europeo Di Oncologia, IRCCS, Milan, Italy.
Clin Sarcoma Res. 2020 Aug 28;10:17. doi: 10.1186/s13569-020-00139-3. eCollection 2020.
Radically resected early uterine leiomyosarcoma (eULMS) is still marked by a poor prognosis. Adjuvant strategies investigated up to now have not been corroborated by controlled studies. We retrospectively reviewed the clinical outcome of eULMS patients treated with adjuvant anthracycline-based or gemcitabine-based chemotherapy at two Italian reference centers.
In this explorative, retrospective, cohort analysis, we included all the consecutive patients with radically resected eULMS treated at two centers between 1997 and 2017.
A total of 109 consecutive patients were included. Sixty-six (60%) received an anthracycline-based regimen, whereas 43 (40%) received a gemcitabine-based regimen. Median disease-free survival (DFS) was 41.3 months with anthracycline-based regimens compared to 20.9 months with gemcitabine-based regimens (HR: 0.49; 95% CI: 0.30-0.80; = 0.004). In the multivariable model, anthracycline-based regimens were independently associated with a better DFS. No difference in terms of overall survival was observed.
DFS was not the same by using an anthracycline-based or a gemcitabine-based adjuvant chemotherapy for patients with radically resected eULMS. The results of our study are in line with recent prospective controlled evidence in limb and superficial trunk soft tissue sarcomas. The role of anthracycline-based adjuvant chemotherapy should still be viewed as a research issue in eULMS.
早期子宫平滑肌肉瘤（eULMS）根治性切除后的预后仍然较差。迄今为止所研究的辅助治疗策略尚未得到对照研究的证实。我们回顾性分析了在意大利两个参考中心接受基于蒽环类药物或吉西他滨的辅助化疗的eULMS患者的临床结局。
在这项探索性、回顾性队列分析中，我们纳入了1997年至2017年间在两个中心接受根治性切除的所有连续的eULMS患者。
共纳入109例连续患者。66例（60%）接受基于蒽环类药物的方案，而43例（40%）接受基于吉西他滨的方案。基于蒽环类药物的方案的中位无病生存期（DFS）为41.3个月，而基于吉西他滨的方案为20.9个月（HR：0.49；95%CI：0.30 - 0.80；P = 0.004）。在多变量模型中，基于蒽环类药物的方案与更好的DFS独立相关。总生存期方面未观察到差异。
对于根治性切除的eULMS患者，使用基于蒽环类药物或基于吉西他滨的辅助化疗，DFS不同。我们的研究结果与近期关于肢体和浅表躯干软组织肉瘤的前瞻性对照证据一致。基于蒽环类药物的辅助化疗在eULMS中的作用仍应视为一个研究问题。
