Obstetrics and Gynecology Department of the University of Insubria, Women's and Children Del Ponte Hospital, Varese, Italy.
Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.
J Surg Oncol. 2024 Mar;129(3):517-522. doi: 10.1002/jso.27509. Epub 2023 Nov 16.
Uterine leiomyosarcomas (uLMS) are rare malignant tumors, often incidentally discovered, with an estimated annual incidence of five cases per one million women in the United States. This study aimed to compare the oncological outcomes of two groups of patients: those with uLMS incidentally found during surgery and those who underwent surgery due to suspected or confirmed uLMS before the procedure. The study assessed patients who had undergone hysterectomy and were diagnosed with stage I uLMS at a tertiary gynecologic oncology referral center in Italy between January 2000 and December 2019. Data on patients' baseline characteristics, surgical procedures, and oncological outcomes were collected. The patients were classified into two groups based on whether uLMS was unexpectedly discovered or suspected before the surgery. Survival rates and factors influencing recurrence were analyzed.
The study included 36 patients meeting the inclusion criteria, with 12 having preoperatively suspected or proven uLMS and 24 having incidentally discovered uLMS. No significant differences were observed between the two groups regarding disease-free survival (23.7 vs. 27.3 months, log rank = 0.28), disease-specific survival (median not reached, log rank = 0.78), or sites of relapse. Notably, among patients who underwent laparoscopic hysterectomy (compared to open surgery), a significantly higher rate of locoregional recurrence was found (78% vs. 33.3%, p = 0.04). Nevertheless, no significant differences in survival were observed based on the surgical approach.
Preoperative suspicion for uLMS did not seem to impact survival outcomes or the pattern of recurrence. Furthermore, although patients who underwent laparoscopic hysterectomy showed a higher rate of locoregional relapse, this did not affect their overall survival.
子宫平滑肌肉瘤（uLMS）是一种罕见的恶性肿瘤，常为偶然发现，在美国，估计每百万女性中有五例该病发病率。本研究旨在比较两组患者的肿瘤学结果：一组为术中偶然发现 uLMS 的患者，另一组为术前因疑似或确诊 uLMS 而行手术的患者。本研究评估了 2000 年 1 月至 2019 年 12 月在意大利一家三级妇科肿瘤学转诊中心行子宫切除术且诊断为 I 期 uLMS 的患者。收集了患者的基线特征、手术程序和肿瘤学结果数据。根据手术前是否意外发现或怀疑 uLMS 将患者分为两组。分析了生存率和影响复发的因素。
本研究共纳入符合纳入标准的 36 例患者，其中 12 例术前疑似或确诊 uLMS，24 例术中偶然发现 uLMS。两组患者无病生存率（23.7 与 27.3 个月，对数秩检验=0.28）、疾病特异性生存率（中位生存期未达到，对数秩检验=0.78）或复发部位无显著差异。值得注意的是，与开腹手术相比，行腹腔镜子宫切除术的患者局部复发率明显更高（78%与 33.3%，p=0.04）。然而，手术方式对生存无显著影响。
术前怀疑 uLMS 似乎不会影响生存结果或复发模式。此外，虽然行腹腔镜子宫切除术的患者局部复发率较高，但这并未影响其总生存。
