Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, USA.
Gynecol Oncol. 2021 Apr;161(1):70-77. doi: 10.1016/j.ygyno.2020.12.032. Epub 2021 Jan 6.
To examine the perioperative and survival outcomes in women with disseminated peritoneal uterine leiomyosarcoma (uLMS) who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
A comprehensive systematic review of literature was conducted using multiple public search engines, PubMed, Scopus, and the Cochrane Library, in compliance with the PRISMA guidelines. Women with disseminated peritoneal uLMS treated with CRS-HIPEC were analyzed. Perioperative morbidity and mortality rate as well as oncologic outcomes related to CRS-HIPEC were assessed.
Ten studies met the inclusion criteria from 2004 to 2020, including 8 case series (n=28) and 2 original articles (n=47). Of the 75 patients, 68 (90.7%) were women with uLMS whereas 7 women were non-uLMS. Of these, 64 (85.3%) had recurrent disease, and 39 (52.0%) received chemotherapy or radiotherapy prior to CRS-HIPEC. The perioperative mortality rate was 4.0% (intraoperative 1.3%, and postoperative 2.7%), and postoperative complications (grade ≥3) rate ranged 21.4-22.2%. With regard to HIPEC regimens (n=75), cisplatin was most frequently used (n=55, 73.3%) followed by melphalan (n=17, 22.7%) and others (n=3, 4.0%). Among the two observational studies, the median overall survival after CRS-HIPEC treatment was 29.5-37 months. In one limited comparative effectiveness study (n=13), albeit statistically non-significant CRS-HIPEC was associated with higher progression-free survival versus CRS alone (3-year rates, 71.4% versus 0%, P=0.10). When the HIPEC regimens were compared, melphalan use was associated with decreased uLMS-related mortality compared to a cisplatin-based regimen, but the association was not statistically significant (hazard ratio 0.35, 95% confidence interval 0.04-3.05, P=0.35).
Effectiveness of CRS-HIPEC for disseminated peritoneal uLMS is yet to be determined. As interpretation of the available data on survival is limited due to small sample sizes or the lack of an active comparator, further study is warranted to examine the safety and survival effect of CRS-HIPEC in disseminated peritoneal uLMS.
研究接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）治疗的播散性腹膜子宫平滑肌肉瘤（uLMS）女性患者的围手术期和生存结局。
根据 PRISMA 指南，使用多个公共搜索引擎、PubMed、Scopus 和 Cochrane 图书馆进行了全面的文献系统综述。分析了接受 CRS-HIPEC 治疗的播散性腹膜 uLMS 女性患者。评估了与 CRS-HIPEC 相关的围手术期发病率和死亡率以及肿瘤学结局。
2004 年至 2020 年期间，有 10 项研究符合纳入标准，包括 8 项病例系列研究（n=28）和 2 项原始文章（n=47）。在 75 名患者中，68 名（90.7%）为 uLMS 女性，7 名为非 uLMS 女性。其中，64 名（85.3%）患有复发性疾病，39 名（52.0%）在 CRS-HIPEC 前接受过化疗或放疗。围手术期死亡率为 4.0%（术中 1.3%，术后 2.7%），术后并发症（≥3 级）发生率为 21.4-22.2%。关于 HIPEC 方案（n=75），顺铂的使用最为频繁（n=55，73.3%），其次是美法仑（n=17，22.7%）和其他药物（n=3，4.0%）。在两项观察性研究中，CRS-HIPEC 治疗后的中位总生存期为 29.5-37 个月。在一项有限的比较有效性研究（n=13）中，尽管统计学上无显著性意义，但与单独 CRS 相比，CRS-HIPEC 与更高的无进展生存率相关（3 年生存率，71.4%与 0%，P=0.10）。当比较 HIPEC 方案时，与顺铂为基础的方案相比，使用美法仑与降低 uLMS 相关死亡率相关，但相关性无统计学意义（风险比 0.35，95%置信区间 0.04-3.05，P=0.35）。
CRS-HIPEC 治疗播散性腹膜 uLMS 的疗效尚待确定。由于样本量小或缺乏活性对照，对现有生存数据的解释受到限制，因此需要进一步研究以检查 CRS-HIPEC 在播散性腹膜 uLMS 中的安全性和生存效果。
