Gynaecology and Gynecologic Oncology, University Hospital Bonn Clinic for Gynaecologic Oncology, Bonn, Germany
Gynaecology and Gynecologic Oncology, University Hospital Bonn Clinic for Gynaecologic Oncology, Bonn, Germany.
Int J Gynecol Cancer. 2022 May 3;32(5):619-625. doi: 10.1136/ijgc-2021-003334.
Benign leiomyomas are the most common uterine tumors. In contrast, uterine leiomyosarcomas are malignancies with a poor prognosis due to difficulties in early diagnosis and inappropriate surgical treatment. Most often they are diagnosed incidentally after surgery performed for treatment of leiomyoma. As the appropriate surgical treatment is crucial for survival of the patient, there is a high demand to predict leiomyosarcoma pre-operatively. Available scoring systems to discriminate leiomyoma from leiomyosarcoma are based on retrospective studies with limited numbers of patients and are not implemented in routine clinical practice.
The aim of our study was to evaluate a recently published score-the pre-operative leiomyosarcoma (pLMS) score-to determine whether it would have been predictive of leiomyosarcoma in 177 patients from the NOGGO-REGSA study, a German register of histologically proven gynecological sarcoma detected during routine clinical investigation.
The threshold of the pLMS score for 'leiomyosarcoma not probable' (< -3) failed for 7.5% of the patients and the threshold 'indicator for leiomyosarcoma' (>+1) was true for 39.1% of the patients. 53.4% of the patients were attributed to the group 'additional investigations are recommended' (-3 to +1). The most relevant parameters in our analysis were suspicious sonography and rapid growth, but neither have been quantitatively defined.
In our validation cohort, the pLMS score seems not to be a reliable tool to predict leiomyosarcoma and therefore we do not recommend its clinical implementation to identify leiomyosarcoma.
良性平滑肌瘤是最常见的子宫肿瘤。相比之下，子宫平滑肌肉瘤是一种恶性肿瘤，由于早期诊断困难和手术治疗不当，预后较差。大多数情况下，它们是在因治疗平滑肌瘤而进行的手术后偶然诊断出来的。由于适当的手术治疗对患者的生存至关重要，因此非常需要在术前预测平滑肌肉瘤。用于区分平滑肌瘤和平滑肌肉瘤的现有评分系统基于回顾性研究，患者数量有限，并未在常规临床实践中实施。
我们的研究目的是评估最近发表的评分系统——术前平滑肌肉瘤（pLMS）评分，以确定它是否可以预测 177 名来自德国妇科肉瘤登记处（NOGGO-REGSA 研究）的患者中的平滑肌肉瘤。该登记处是在常规临床研究中发现的组织学证实的妇科肉瘤。
pLMS 评分的“不太可能为平滑肌肉瘤”（<-3）的阈值对 7.5%的患者不适用，而“提示平滑肌肉瘤”（>+1）的阈值对 39.1%的患者适用。53.4%的患者被归入“建议进一步检查”（-3 至+1）组。在我们的分析中，最相关的参数是可疑的超声检查和快速生长，但两者都没有被定量定义。
在我们的验证队列中，pLMS 评分似乎不是预测平滑肌肉瘤的可靠工具，因此我们不建议将其用于临床以识别平滑肌肉瘤。
