Effectiveness of adjuvant treatment for morcellated, International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma: A Korean multicenter study

Se Ik Kim, Chel Hun Choi, Kidong Kim, Deok Ho Hong, Jeong Yeol Park, Byung Su Kwon, Keun Ho Lee, Dae Gy Hong, So Jin Shin, Sang Il Park, Yun Hwan Kim, Seung Ho Lee, Sanghoon Lee, Jin Hwa Hong, Jung Yun Lee, Yong Beom Kim, Jae Hong No, Dong Hoon Suh

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Abstract

Aim: To evaluate the effectiveness of adjuvant treatment for morcellated, uterus-confined leiomyosarcoma in a multicenter setting. Methods: We identified patients with International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma primarily treated with surgery between 2003 and 2016. Among them, patients who underwent one of the following morcellation methods were included: (i) power morcellation; (ii) intracorporeal morcellation using scalpels or electrocautery; and (iii) vaginal morcellation. Patients' survival outcomes were compared according to the implementation of adjuvant treatment. Results: From 13 institutions, 55 patients were included; 31 for adjuvant treatment group and 24 for surgery only group. The clinicopathological characteristics including the mass size, morcellation methods, extent of surgery, and mitotic count were similar between the groups. In the adjuvant treatment group, 67.7%, 19.4% and 12.9% of patients received chemotherapy, chemoradiation and radiation, respectively. After a median follow-up of 50.5 months, the adjuvant treatment and surgery only groups showed similar overall survival (5-year rate, 92.0% vs 90.4%; P = 0.959). No significant difference in progression-free survival was observed between the two groups (3-year rate, 46.1% vs 78.2%; P = 0.069). On multivariate analyses, adjuvant treatment did not affect progression-free survival (adjusted HR, 2.138; 95% CI, 0.550–8.305; P = 0.273). The adjuvant treatment group showed a trend towards more common distant metastasis, compared to the surgery only group (25.8% vs 4.2%; P = 0.062). The incidences of pelvic, retroperitoneal, and abdominal recurrences were not different between the groups. Conclusion: Despite its frequent use in clinical practice, adjuvant treatment did not improve the survival outcomes of patients with morcellated, International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma.

Original languageEnglish
Pages (from-to)337-346
Number of pages10
JournalJournal of Obstetrics and Gynaecology Research
Volume46
Issue number2
DOIs
Publication statusPublished - 2020 Feb 1

Keywords

  • adjuvant treatment
  • leiomyosarcoma
  • prognosis
  • recurrence
  • survival
  • uterine neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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  • Cite this

    Kim, S. I., Choi, C. H., Kim, K., Hong, D. H., Park, J. Y., Kwon, B. S., Lee, K. H., Hong, D. G., Shin, S. J., Park, S. I., Kim, Y. H., Lee, S. H., Lee, S., Hong, J. H., Lee, J. Y., Kim, Y. B., No, J. H., & Suh, D. H. (2020). Effectiveness of adjuvant treatment for morcellated, International Federation of Gynecology and Obstetrics stage I uterine leiomyosarcoma: A Korean multicenter study. Journal of Obstetrics and Gynaecology Research, 46(2), 337-346. https://doi.org/10.1111/jog.14171