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Haddox CL, Papke DJ, Serrano C. Leiomyosarcoma Therapeutic Approaches and Future Directions. Hematol Oncol Clin North Am 2025:S0889-8588(25)00045-0. [PMID: 40410055 DOI: 10.1016/j.hoc.2025.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Abstract
Leiomyosarcomas (LMS) are mesenchymal malignancies with smooth muscle differentiation that most commonly arise in the uterus, retroperitoneum, and extremity. Clinical course is variable, and management differs by site of origin. Recently completed and ongoing clinical trials are optimizing LMS management, and multidisciplinary care by an expert team is essential to navigate the nuances and provide optimal care. Advances in molecular characterization have improved diagnosis and identification of novel prognostic factors and systemic therapies. This article provides an overview of LMS presentation, diagnosis, molecular features, and clinical management, and highlights advancements in LMS biology and treatment.
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Affiliation(s)
- Candace L Haddox
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - David J Papke
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Pathology, Harvard Medical School
| | - César Serrano
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Sarcoma Translational Research Group, Natzaret, 115-11708035 Barcelona, Spain
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2
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Ray MD, Kapoor R, Bn N. Multimodal management of peritoneal sarcomatosis in uterine sarcoma: Long term outcomes from a single institute in India. Eur J Obstet Gynecol Reprod Biol 2025; 311:114042. [PMID: 40359870 DOI: 10.1016/j.ejogrb.2025.114042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 05/06/2025] [Accepted: 05/09/2025] [Indexed: 05/15/2025]
Abstract
OBJECTIVE To assess the outcomes of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis (PS) from uterine sarcoma at a tertiary oncology center in India. METHODS A retrospective analysis of uterine sarcoma patients with PS who underwent CRS + HIPEC. Key outcomes included survival, completeness of cytoreduction (CC score), and postoperative morbidity. RESULTS Median patient age was 53 years, with uterine leiomyosarcoma and endometrial stromal sarcoma as the predominant histology. All patients received preoperative chemotherapy, mainly gemcitabine/docetaxel or ifosfamide. The median Peritoneal Carcinomatosis Index (PCI) was 12, with 85 % of patients having PCI < 15. Complete cytoreduction (CC-0) was achieved in 94 %. Median overall survival (OS) was 34 months, with 1-year, 3-year, and 5-year OS rates of 78 %, 53 %, and 35 %. Disease recurrence remained high (67 %), with a median progression-free survival (PFS) of 14 months. CONCLUSION CRS + HIPEC is a promising therapeutic approach for select uterine sarcoma patients with PS, offering high cytoreduction rates and extended survival. Further studies are needed to optimize patient selection and refine treatment protocols.
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Affiliation(s)
- M D Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rohan Kapoor
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Bn
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Algeri P, Adorni M, Besana G, Carlini L, Ciammella M, Garbo S, Villa A. Navigating diagnostic challenges: case reports on differentiating uterine fibroids from leiomyosarcoma through imaging and clinical evaluation. J Ultrasound 2025:10.1007/s40477-025-00991-3. [PMID: 39904952 DOI: 10.1007/s40477-025-00991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/15/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Differentiating between uterine fibroids and leiomyosarcoma poses significant challenges, particularly in cases of atypical fibroid degeneration. Accurate diagnosis is crucial for appropriate treatment and patient outcomes. METHODS We present two case reports to illustrate the complexities involved in distinguishing these conditions. Both cases involved patients with similar clinical presentations and imaging findings. The diagnostic process included trans-abdominal and trans-vaginal ultrasound, CT scans, and histopathological examination. RESULTS In Case 1, the patient presented with worsening abdominal pain and imaging revealed multiple myomas. Histological examination confirmed benign fibroids following surgery. Case 2 involved a patient with an abdominal mass and CT findings suggestive of a fibroid. However, ultrasound characteristics raised suspicion of malignancy, and subsequent histopathological analysis confirmed leiomyosarcoma. CONCLUSION These case reports underscore the importance of combining clinical evaluation with advanced imaging techniques for accurate differentiation between uterine fibroids and leiomyosarcoma. While ultrasound plays a critical role, its effectiveness is enhanced by the experience of the sonographer and the integration of other diagnostic modalities. Future multicenter studies should focus on refining these diagnostic approaches to improve accuracy and patient outcomes.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy.
| | - Marco Adorni
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Giulia Besana
- School of Gynaecology and Obstetrics, University of Milano Bicocca, San Gerardo Hospital, Monza, Monza e Brianza, Italy
| | - Laura Carlini
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Massimo Ciammella
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Stefano Garbo
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Antonella Villa
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Cagnacci A, Villa P, Grassi GP, Biglia N, Gambacciani M, Di Carlo C, Nocera F, Caruso S, Becorpi A, Lello S, Paoletti AM, Group of Special Interest on Menopause of the Italian Society of Gynecology and Obstetrics (SIGO). Systemic hormone therapy after breast and gynecological cancers: an Italian expert group consensus opinion. Climacteric 2025; 28:4-14. [PMID: 39503540 DOI: 10.1080/13697137.2024.2418503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 09/10/2024] [Accepted: 10/09/2024] [Indexed: 11/08/2024]
Abstract
The specific Italian Group of Study of the Menopause formulated a consensus opinion on the use of estrogen therapy (ET) or combined estro-progestin hormone therapy (HT) after breast and gynecological cancers. This consensus is based on the risk of recurrence of the specific cancer during ET/HT, the presence of steroid receptors in cancer cells, the use of adjuvant hormone therapies and data on the use of ET/HT after cancer. The following positions were reached. ET/HT can be used after vulvar cancers and melanoma, but with great caution after the rare adenocarcinomas. ET/HT can be used after cervical cancer, but ET should be used with caution after adenocarcinomas. ET/HT can be used after International Federation of Obstetrics and Gynecology (FIGO) stage I-II estrogen-dependent endometrial cancers, except in Black women, and can probably be used after estrogen-independent endometrial cancers. ET/HT cannot be administered or should be used with great caution after most uterine sarcomas. ET/HT can probably be used after ovarian neoplasms except for granulosa cell tumors, and with great caution after low-grade serous ovarian carcinoma and serous borderline ovarian tumors. ET/HT can be used with great caution in women after estrogen receptor (ER)/progesterone receptor (PR)-positive breast cancer and is probably allowed after ER/PR-negative breast cancer.
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Affiliation(s)
- Angelo Cagnacci
- Teaching Unit of Obstetrics and Gynecology, DINOGMI San Martino Hospital of Genova, Genova, Italy
| | - Paola Villa
- Department of Women's and Child Health and Public Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppina Paola Grassi
- University Division '1U' of Gynecology and Obstetrics, Sant'Anna Hospital of Torino, Turin, Italy
| | - Nicoletta Biglia
- Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Gambacciani
- Menopause and Osteoporosis Unit, San Rossore Clinical Center, Pisa, Italy
| | - Costantino Di Carlo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Salvatore Caruso
- Research Center for Study of Prevention, Diagnosis and Treatment of Neoplasms (CRS-PreDiCT), University of Catania, Catania, Italy
| | - Angelamaria Becorpi
- Department of Obstetrics and Gynecology of Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano Lello
- Department of Women's and Child Health and Public Health Science, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Anna Maria Paoletti
- Coordinator of the Italian Group of Special Interest on Menopause of the Italian Society of Obstetrics and Gynecology, Women's Wellness Foundation, Cagliari, Italy
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Mactier KE, Baxter MA, Peters AL, Fair K, Hannington L, Robertson J, Wood GE, Sarwar A, Bishr MK, Webb R, Al-Zubaidi M, Eastlake L, Lankester K, McInerney S, Creedon H, Stillie AL, Purshouse K, The National Oncology Trainee Collaborative for Healthcare Research. TOURISM study (Treatment Outcomes in UteRIne SarcoMa): a 10-year retrospective evaluation of practice in the UK. BMJ Open 2024; 14:e094838. [PMID: 39725428 PMCID: PMC11683892 DOI: 10.1136/bmjopen-2024-094838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 11/28/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Although rare, uterine sarcomas account for a high proportion of uterine cancer mortality. Treatment options and robust trial data are limited. OBJECTIVES The TOURISM study (Treatment Outcomes in UteRIne SarcoMa) is a UK-wide study by the National Oncology Trainees Collaborative for Healthcare Research which aimed to characterise this patient cohort. DESIGN A retrospective descriptive cohort study. Patients with carcinosarcomas/mixed Mullerian tumours, non-uterine gynaecological sarcomas and uterine metastases were excluded. Routine clinical data, including general patient demographics, diagnosis, treatment and outcomes, were collated and pseudonymised. SETTING Patients diagnosed with uterine sarcoma in the UK National Health Service between 1 January 2008 and 31 December 2017 were identified from electronic records. PARTICIPANTS A total of 406 patients from eight centres were eligible for inclusion. RESULTS The median age at diagnosis was 56 years, with leiomyosarcoma the most common diagnosis (54.4%). The majority (57.9%) were diagnosed at the International Federation of Gynecology and Obstetrics stage I, with 19.7% diagnosed at stage IV. Nearly half (45.2%) of the patients received at least one line of chemotherapy, of which most (81.0%) received doxorubicin first-line. In the stage I group 7.4% received adjuvant chemotherapy and 15.0% received adjuvant radiotherapy. Median overall survival was 37 months; however, survival varied significantly by stage at diagnosis (stage I: 105 months; stage II: 33 months; stage III: 19 months; stage IV: 14 months). CONCLUSIONS Our data highlight the diversity in patient management in uterine sarcoma and a marked survival advantage for patients diagnosed with stage I disease. These data highlight the importance of a multidisciplinary approach and describe real-world trends in systemic therapies, radiotherapy and surgical treatment in this rare cancer type.
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Affiliation(s)
- Karen E Mactier
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | - Adam L Peters
- The Beatson Institute for Cancer Research, Glasgow, UK
| | | | | | - James Robertson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Ayrshire Hospice, Ayr, South Ayrshire, UK
| | - Georgina E Wood
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Asma Sarwar
- Radiotherapy, University College Hospital, London, UK
| | - Mai K Bishr
- The Institute of Cancer Research, London, UK
| | - Rebekah Webb
- Nottingham City Hospital Cancer Care, Nottingham, UK
- Royal Derby Hospital, Derby, UK
| | | | | | | | - Samuel McInerney
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Royal Sussex County Hospital, Brighton, UK
| | - Helen Creedon
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Alison L Stillie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Karin Purshouse
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - The National Oncology Trainee Collaborative for Healthcare Research
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- Ninewells Hospital and Medical School, Dundee, UK
- The Beatson Institute for Cancer Research, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Ayrshire Hospice, Ayr, South Ayrshire, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- Radiotherapy, University College Hospital, London, UK
- The Institute of Cancer Research, London, UK
- Nottingham City Hospital Cancer Care, Nottingham, UK
- Royal Derby Hospital, Derby, UK
- Weston Park Hospital, Sheffield, UK
- Royal Cornwall Hospital, Truro, UK
- Royal Sussex County Hospital, Brighton, UK
- Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK
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Yuan H, Li N, Wu L, Yao H. Prognosis and treatment of uterine sarcoma found incidentally after myomectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108652. [PMID: 39241509 DOI: 10.1016/j.ejso.2024.108652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To determine prognosis and factors associated with survival of women with uterine sarcoma found incidentally after myomectomy. METHODS We performed a retrospective study for patients who had previously undergone myomectomy for presumed benign uterine fibroid disease and were found to have uterine confined sarcoma after myomectomy surgery. RESULTS In total, 50 patients were identified. There were 23 (46.0 %) patients undergoing myomectomy were performed by minimal invasive surgery: laparoscopic (Lap, n = 22, 44.0 %) or transvaginal (TV, n = 1, 2.0 %) approach; while, 24 (48.0 %) and 3 (6.0 %) patients had myomectomy through abdominal (Abd) or hysteroscopic (Hys) approach. All patients received the re-exploration and staging surgery in our center. The median time from myomectomy to the staging surgery was 43 days (range 15-90 days). 17 patients had remnant sarcomas on the remaining uterus and 6 patients had disseminated disease after re-exploration. In the entire cohort, 5-year RFS and 5-year OS was 79.4 % and 88.0 %, respectively. Patients who received initial Lap/TV myomectomy had a tendency towards a worse 5-year RFS compared with Abd/Hys approach (63.0 % vs 88.9 %, P = 0.080). No difference in 5-year OS was found between the two groups (90.3 % vs 91.8 %, P = 0.768). For stage I disease (n = 44), patients who received Lap/TV myomectomy had a worse 5-year RFS compared with Abd/Hys approach (58.3 % vs 95.7 %, P = 0.009). No difference in 5-year OS was found (P = 0.121). CONCLUSION Patients with incidental uterine sarcoma who received primary Lap/TV myomectomy may have a worse RFS. Re-exploration can detect remnant or disseminated sarcomas.
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Affiliation(s)
- Hua Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Li
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Wang W, Hu Y, Fu F, Ren W, Wang T, Wang S, Li Y. Advancement in Multi-omics approaches for Uterine Sarcoma. Biomark Res 2024; 12:129. [PMID: 39472980 PMCID: PMC11523907 DOI: 10.1186/s40364-024-00673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/14/2024] [Indexed: 11/02/2024] Open
Abstract
Uterine sarcoma (US) is a rare malignant tumor that has various pathological types and high heterogeneity in the female reproductive system. Its subtle early symptoms, frequent recurrence, and resistance to radiation and chemotherapy make the prognosis for US patients very poor. Therefore, understanding the molecular mechanisms underlying tumorigenesis and progression is essential for an accurate diagnosis and targeted therapy to improve patient outcomes. Recent advancements in high-throughput molecular sequencing have allowed for a deeper understanding of diseases through multi-omics technologies. In this review, the latest progress and future potential of multi-omics technologies in US research is examined, and their roles in biomarker discovery and their application in the precise diagnosis and treatment of US are highlighted.
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Affiliation(s)
- Wuyang Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Yu Hu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Fangfang Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Wu Ren
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China
| | - Tian Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
| | - Yan Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Anv. Wuhan, Wuhan, Hubei, 430030, P.R. China.
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Wang T, Yuan H, Li L, Yao H. Clinicopathological and survival analysis for patients with uterine sarcoma treated following surgery for presumed benign disease. BMC Cancer 2024; 24:1118. [PMID: 39251969 PMCID: PMC11382451 DOI: 10.1186/s12885-024-12881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVES To investigate the clinicopathological characteristics and prognosis of patients with uterine sarcoma treated following surgery for presumed benign disease. METHODS We identified all patients with uterine sarcoma found incidentally after primary surgery for presumed benign disease who presented to our institution and received re-exploration for completion surgery from January 1, 2004 to January 1, 2021. We analyzed the clinicopathological characteristics and prognosis. RESULTS Overall, 95 patients were included in our study. For the initial surgery, myomectomy was performed in 50 (52.6%, 50/95) patients, hysterectomy was performed in 45 (47.4%, 45/95) patients. All patients were re-explored to complete the staging operation. The median time to the staging surgery was 40 days (range 15-90 days). There were 29 patients (30.5%, 29/95) had remnant sarcomas, with 17 patients (17/95, 17.9%) on the remaining uterus, 9 patients (9/95, 9.5%) had disseminated diseases, and 4 patients (4/95, 4.2%) had positive lymph nodes. About 40 patients (42.1%) received adjuvant chemotherapy, 55.2% (16/29) and 36.4% (24/66) patients with/without remnant diseases received adjuvant chemotherapy, respectively (P = 0.087). The median follow-up duration was 76.7 months (IQR: 34.8-118.1 months). And 17 patients (17.9%) had recurrence following re-exploration surgery. 5-year progression-free survival (PFS) and 5-year overall survival (OS) for the entire cohort was 81.7% and 92.1%, respectively. Patients with remnant sarcomas had a tendency towards a worse 5-year PFS and 5-year OS, compared with those without (5-year PFS: 75.6% vs. 84.5%, P = 0.224; 5-year OS: 85.5% vs. 95.1%, P = 0.217). Patients with disseminated diseases had a worse 5-year OS (62.5% vs. 95.1%, P = 0.007) and non-significantly worse 5-year PFS (64.8% vs. 83.4%, P = 0.153) compared with those without. CONCLUSIONS Patients with uterine sarcoma treated following surgery for presumed benign disease have a favorable survival. Patients with disseminated diseases had a worse 5-year OS compared with those without. Surgical re-exploration may be valuable for removing remnant sarcomas and disseminated diseases.
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Affiliation(s)
- Tonghui Wang
- Department of Clinical Laboratory, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hua Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 # Panjiayuannanli, Chaoyang District, Beijing, 100021, P. R. China
| | - Lihong Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Hongwen Yao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 # Panjiayuannanli, Chaoyang District, Beijing, 100021, P. R. China.
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Aggarwal A, Ferrari F, Zouridis A, Kehoe S, Pratap S, Gozzini E, Soleymani Majd H. Survival Trends for Uterine Sarcomas from a Tertiary Center: The Oxford Experience. Diseases 2024; 12:200. [PMID: 39329869 PMCID: PMC11431625 DOI: 10.3390/diseases12090200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/24/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
Uterine sarcomas are rare and aggressive gynecological malignancies. We evaluated the epidemiology, treatment outcomes and survival rates in uterine sarcoma patients managed in our institute. The medical records of women with histology proven uterine sarcoma, including leiomyosarcoma (LMS), adenosarcoma (ADS), and endometrial stromal sarcoma (ESS), treated at our institution from February 2010 to February 2022, were analyzed. In total, 41 patients were identified. In detail, LMS, ADS, and high-grade and low-grade ESS were identified, respectively, in 60.9%, 19.5%, 12.1%, and 7.3% of the cases. The majority of women affected by LMS (72%) underwent primary surgery and 40% of them also received adjuvant chemotherapy. A surgical approach was the preferred mode of treatment in 83% of the recurrences. The median OS (overall survival), DFS (disease free survival), and PFS (progression free survival) for the LMS group were 25, 44.5, and 8 months, respectively. The 5-year survival rates for LMS, ADS, and ESS groups were 30.5%, 100% and 37.5%, respectively. The 5-year survival for LMS was found to be significantly worse than for other histology types (p = 0.016). Our study provides valuable data for the evaluation of treatment strategies and survival trends among these rare cancers. The management and follow-up planning of each subtype requires a thorough patient-focused multidisciplinary discussion.
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Affiliation(s)
- Aakriti Aggarwal
- Department of Obstetrics and Gynecology, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 9DU, UK;
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, Obstetrics and Gynecology, University of Brescia, 25100 Brescia, Italy
| | - Andreas Zouridis
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK (S.K.)
| | - Sean Kehoe
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK (S.K.)
| | - Sarah Pratap
- Department of Clinical Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK;
| | - Elisa Gozzini
- Department of Clinical and Experimental Sciences, Obstetrics and Gynecology, University of Brescia, 25100 Brescia, Italy
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK (S.K.)
- Nuffield Department of Women’s Reproductive Health, Medical Sciences Division, Oxford University, Oxford OX3 9DU, UK
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10
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Asano F, Morisada T, Momomura M, Shibuya H, Matsumoto H, Kobayashi Y. Prognostic Factors in Uterine Sarcoma Based on the Tumor Size Stratification: A Retrospective Study. Cureus 2024; 16:e65819. [PMID: 39219878 PMCID: PMC11362873 DOI: 10.7759/cureus.65819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Uterine sarcoma is a rare malignant gynecological tumor with a poor prognosis. Many studies have identified the clinical stage as an important prognostic factor; however, the heterogeneity of patient distribution in the International Federation of Gynecology and Obstetrics (FIGO) stage has reportedly required further revision. Therefore, this study retrospectively investigated the factors related to the prognosis of uterine sarcoma, with particular attention to tumor size, which can be evaluated preoperatively. METHODS Clinical data were extracted from the medical records of patients with uterine sarcoma treated between January 2010 and January 2023. Kaplan-Meier survival curves were plotted according to clinical factors such as histological type, clinical stage, chemotherapy, and tumor size. Factors that were significant in the univariate analysis were subjected to the multivariate analysis using Cox proportional hazards regression. RESULTS Thirty-four patients with uterine sarcoma, comprising 24 (70.5%), five (14.7%), three (8.8%), and two (5.9%) with leiomyosarcoma, undifferentiated sarcoma, high-grade endometrial stromal sarcoma, and low-grade endometrial stromal sarcoma, respectively, were included. Based on the FIGO stage, 15 (44.1%), six (17.6%), three (8.8%), and 10 patients had stage I, II, III, and IV disease, respectively, at the time of diagnosis. All patients underwent surgery as initial treatment; 15 received postoperative chemotherapy. Among the 32 patients with uterine leiomyosarcoma, undifferentiated sarcoma, or high-grade endometrial stromal sarcoma, overall survival differed significantly in the univariate analysis based on disease stage (I + II vs. III + IV) and tumor size (≤10 vs. >10 cm). However, only tumor size was an independent prognostic factor in the multivariate analysis. CONCLUSION Tumor size (≤10 vs. >10 cm) may possibly have a prognostic impact on uterine sarcoma.
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Affiliation(s)
- Fumio Asano
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
| | - Mai Momomura
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
| | - Hiromi Shibuya
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
| | - Hironori Matsumoto
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
| | - Yoichi Kobayashi
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, JPN
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11
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Raffone A, Raimondo D, Neola D, Travaglino A, Doglioli M, Ambrosio M, Raimondo I, De Meis L, Turco LC, Cosentino F, Seracchioli R, Casadio P, Mollo A. Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:293-304. [PMID: 37562447 DOI: 10.1055/a-2151-9205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To assess the prevalence of sonographic signs in women with uterine sarcoma. MATERIALS AND METHODS A systematic review and meta-analysis were performed. Five electronic databases were searched from inception to June 2022 for all studies allowing calculation of the prevalence of sonographic signs in women with uterine sarcoma. Pooled prevalence with 95% confidence intervals was calculated for each sonographic sign and was a priori defined as "very high" when it was ≥ 80%, "high" when it ranged from 80% to 70%, and less relevant when it was ≤ 70%. RESULTS 6 studies with 317 sarcoma patients were included. The pooled prevalence was: · 25.0% (95%CI:15.4-37.9%) for absence of visibility of the myometrium. · 80.5% (95%CI:74.8-85.2%) for solid component. · 78.3% (95%CI:59.3-89.9%) for inhomogeneous echogenicity of solid component. · 47.9% (95%CI:41.1-54.8%) for cystic areas. · 80.7% (95%CI:68.3-89.0%) for irregular walls of cystic areas. · 72.3% (95%CI:16.7-97.2%) for anechoic cystic areas. · 54.8% (95%CI:34.0-74.1%) for absence of shadowing. · 73.5% (95%CI:43.3-90.9%) for absence of calcifications. · 48.7% (95%CI:18.6-79.8%) for color score 3 or 4. · 47.3% (95%CI:37.0-57.8%) for irregular tumor borders. · 45.4% (95%CI:27.6-64.3%) for endometrial cavity not visualizable. · 10.9% (95%CI:3.5-29.1%) for free pelvic fluid. · 6.4% (95%CI:1.1-30.2%) for ascites. · 21.2% (95%CI:2.1-76.8%) for intracavitary process. · 81.5% (95%CI:56.1-93.8%) for singular lesion.. CONCLUSION Solid component, irregular walls of cystic areas, and singular lesions are signs with very high prevalence, while inhomogeneous echogenicity of solid component, anechoic cystic areas, and absence of calcifications are signs with high prevalence. The remaining signs were less relevant.
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Affiliation(s)
- Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Daniele Neola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Antonio Travaglino
- Department of Woman's Health Science, University Hospital Agostino Gemelli, Roma, Italy
| | - Marisol Doglioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Ambrosio
- Mother-Child Department, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy
| | - Ivano Raimondo
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Lucia De Meis
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Carlo Turco
- Department of Woman's Health Science, University Hospital Agostino Gemelli, Roma, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Fisciano, Italy
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12
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Toyohara Y, Sone K, Noda K, Yoshida K, Kato S, Kaiume M, Taguchi A, Kurokawa R, Osuga Y. The automatic diagnosis artificial intelligence system for preoperative magnetic resonance imaging of uterine sarcoma. J Gynecol Oncol 2024; 35:e24. [PMID: 38246183 PMCID: PMC11107276 DOI: 10.3802/jgo.2024.35.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is efficient for the diagnosis of preoperative uterine sarcoma; however, misdiagnoses may occur. In this study, we developed a new artificial intelligence (AI) system to overcome the limitations of requiring specialists to manually process datasets and a large amount of computer resources. METHODS The AI system comprises a tumor image filter, which extracts MRI slices containing tumors, and sarcoma evaluator, which diagnoses uterine sarcomas. We used 15 types of MRI patient sequences to train deep neural network (DNN) models used by tumor filter and sarcoma evaluator with 8 cross-validation sets. We implemented tumor filter and sarcoma evaluator using ensemble prediction technique with 9 DNN models. Ten tumor filters and sarcoma evaluator sets were developed to evaluate fluctuation accuracy. Finally, AutoDiag-AI was used to evaluate the new validation dataset, including 8 cases of sarcomas and 24 leiomyomas. RESULTS Tumor image filter and sarcoma evaluator accuracies were 92.68% and 90.50%, respectively. AutoDiag-AI with the original dataset accuracy was 89.32%, with 90.47% sensitivity and 88.95% specificity, whereas AutoDiag-AI with the new validation dataset accuracy was 92.44%, with 92.25% sensitivity and 92.50% specificity. CONCLUSION Our newly established AI system automatically extracts tumor sites from MRI images and diagnoses them as uterine sarcomas without human intervention. Its accuracy is comparable to that of a radiologist. With further validation, the system could be applied for diagnosis of other diseases. Further improvement of the system's accuracy may enable its clinical application in the future.
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Affiliation(s)
- Yusuke Toyohara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | | | | | - Shimpei Kato
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kaiume
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Santoro M, Zybin V, Coada CA, Mantovani G, Paolani G, Di Stanislao M, Modolon C, Di Costanzo S, Lebovici A, Ravegnini G, De Leo A, Tesei M, Pasquini P, Lovato L, Morganti AG, Pantaleo MA, De Iaco P, Strigari L, Perrone AM. Machine Learning Applied to Pre-Operative Computed-Tomography-Based Radiomic Features Can Accurately Differentiate Uterine Leiomyoma from Leiomyosarcoma: A Pilot Study. Cancers (Basel) 2024; 16:1570. [PMID: 38672651 PMCID: PMC11048510 DOI: 10.3390/cancers16081570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The accurate discrimination of uterine leiomyosarcomas and leiomyomas in a pre-operative setting remains a current challenge. To date, the diagnosis is made by a pathologist on the excised tumor. The aim of this study was to develop a machine learning algorithm using radiomic data extracted from contrast-enhanced computed tomography (CECT) images that could accurately distinguish leiomyosarcomas from leiomyomas. METHODS Pre-operative CECT images from patients submitted to surgery with a histological diagnosis of leiomyoma or leiomyosarcoma were used for the region of interest identification and radiomic feature extraction. Feature extraction was conducted using the PyRadiomics library, and three feature selection methods combined with the general linear model (GLM), random forest (RF), and support vector machine (SVM) classifiers were built, trained, and tested for the binary classification task (malignant vs. benign). In parallel, radiologists assessed the diagnosis with or without clinical data. RESULTS A total of 30 patients with leiomyosarcoma (mean age 59 years) and 35 patients with leiomyoma (mean age 48 years) were included in the study, comprising 30 and 51 lesions, respectively. Out of nine machine learning models, the three feature selection methods combined with the GLM and RF classifiers showed good performances, with predicted area under the curve (AUC), sensitivity, and specificity ranging from 0.78 to 0.97, from 0.78 to 1.00, and from 0.67 to 0.93, respectively, when compared to the results obtained from experienced radiologists when blinded to the clinical profile (AUC = 0.73 95%CI = 0.62-0.84), as well as when the clinical data were consulted (AUC = 0.75 95%CI = 0.65-0.85). CONCLUSIONS CECT images integrated with radiomics have great potential in differentiating uterine leiomyomas from leiomyosarcomas. Such a tool can be used to mitigate the risks of eventual surgical spread in the case of leiomyosarcoma and allow for safer fertility-sparing treatment in patients with benign uterine lesions.
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Affiliation(s)
- Miriam Santoro
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.S.); (G.P.); (L.S.)
| | - Vladislav Zybin
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (V.Z.); (C.M.); (L.L.)
| | | | - Giulia Mantovani
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
| | - Giulia Paolani
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.S.); (G.P.); (L.S.)
| | - Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
| | - Cecilia Modolon
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (V.Z.); (C.M.); (L.L.)
| | - Stella Di Costanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, 400347 Cluj-Napoca, Romania;
- Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy;
| | - Antonio De Leo
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Tesei
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
| | - Pietro Pasquini
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
| | - Luigi Lovato
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (V.Z.); (C.M.); (L.L.)
| | - Alessio Giuseppe Morganti
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Abbondanza Pantaleo
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.S.); (G.P.); (L.S.)
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.M.); (M.D.S.); (S.D.C.); (M.T.); (P.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (A.D.L.); (A.G.M.); (M.A.P.)
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14
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Raffone A, Raimondo D, Neola D, Travaglino A, Giorgi M, Lazzeri L, De Laurentiis F, Carravetta C, Zupi E, Seracchioli R, Casadio P, Guida M. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 165:22-33. [PMID: 37732472 DOI: 10.1002/ijgo.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Differential diagnosis between uterine leiomyomas and sarcomas is challenging. Magnetic resonance imaging (MRI) represents the second-line diagnostic method after ultrasound for the assessment of uterine masses. OBJECTIVES To assess the accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas. SEARCH STRATEGY A systematic review and meta-analysis was performed searching five electronic databases from their inception to June 2023. SELECTION CRITERIA All peer-reviewed observational or randomized clinical trials that reported an unbiased postoperative histologic diagnosis of uterine leiomyoma or uterine sarcoma, which also comprehended a preoperative MRI evaluation of the uterine mass. DATA COLLECTION AND ANALYSIS Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic of MRI in differentiating uterine leiomyomas and sarcomas were calculated as individual and pooled estimates, with 95% confidence intervals (CI). RESULTS Eight studies with 2495 women (2253 with uterine leiomyomas and 179 with uterine sarcomas), were included. MRI showed pooled sensitivity of 0.90 (95% CI 0.84-0.94), specificity of 0.96 (95% CI 0.96-0.97), positive likelihood ratio of 13.55 (95% CI 6.20-29.61), negative likelihood ratio of 0.08 (95% CI 0.02-0.32), diagnostic odds ratio of 175.13 (95% CI 46.53-659.09), and area under the curve of 0.9759. CONCLUSIONS MRI has a high diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas.
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Affiliation(s)
- Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | | | - Carlo Carravetta
- Obstetrics and Gynecology Unit, Salerno ASL, "Villa Malta" Hospital, Sarno, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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15
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Istl AC, Desravines N, Nudotor R, Stone R, Greer JB, Meyer CF, Johnston FM. Treatment patterns and outcomes for primary uterine leiomyosarcoma with synchronous isolated lung metastases: A National Cancer Database study of primary resection and metastasectomy. Gynecol Oncol Rep 2024; 51:101308. [PMID: 38174328 PMCID: PMC10758710 DOI: 10.1016/j.gore.2023.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Background One third of patients with uterine leiomyosarcomas (uLMS) present with distant metastases. Current guidelines do not include recommendations around surgery for metastatic uLMS. Patients with distant metastases commonly receive primary tumor resection for symptoms and so oncologic outcomes after surgery warrant exploration. We describe treatment patterns and outcomes for uLMS patients with synchronous isolated lung metastases (SILM). Methods This retrospective analysis of the National Cancer Database identified patients with uLMS and SILM. Patients with non-pulmonary metastases were excluded. We collected demographic, disease, and treatment characteristics and assessed clinicopathologic factors associated with the receipt of surgery on multivariate regression. Median, 1-year, and 5-year overall survival (OS) across treatment approaches were compared using Kaplan-Meier curves and log-rank tests. Multivariate Cox proportional hazard regressions identified independent predictors of survival. Results We identified 905 patients with uLMS and SILM between 2004 and 2017. 600 patients had primary tumor resection; 63 also had curative intent surgery with metastasectomy. Patients who did not receive chemotherapy were older (p<0.01) with a higher comorbidity index (p<0.05). Women with private health insurance were more likely to receive chemotherapy (p<0.01) and primary tumor resection (p<0.01). Patients who underwent curative intent surgery had 1-year OS of 71.2% and 5-year survival of 18% compared to 1-year survival of 35.6 % and 5-year survival of 5.16 % for patients who had no surgery. Black women had poorer survival on multivariate regression. Conclusions Primary tumor resection and curative intent surgery are associated with improved OS in uLMS with SILM and may be a reasonable treatment option in appropriately selected patients.
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Affiliation(s)
- Alexandra C. Istl
- Division of Surgical Oncology, Medical College of Wisconsin, United States
| | | | - Richard Nudotor
- Department of Surgery, Anne Arundel Medical Center, United States
| | - Rebecca Stone
- Division of Gynecologic Oncology, Johns Hopkins Hospital, United States
| | - Jonathan B. Greer
- Division of Surgical Oncology, Johns Hopkins Hospital, United States
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16
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Du J, Hu D, Xing Y, He R, Cheng Y, Li H, Liu C, Liang X, Yang Y. Correlation between malignant peritoneal cytology and survival in patients with uterine leiomyosarcoma and endometrial stromal sarcoma. Int J Gynecol Cancer 2024; 34:58-65. [PMID: 37821125 DOI: 10.1136/ijgc-2023-004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE This study aimed to examine the correlation between malignant peritoneal cytology and overall survival among patients with uterine leiomyosarcoma and endometrial stromal sarcoma. METHODS Patients with uterine leiomyosarcoma and endometrial stromal sarcoma between January 2010 and December 2016 were identified from the Surveillance, Epidemiology, and End Results database. The multiple imputation method was used to address missing values. Propensity score matching was conducted to balance baseline data between the malignant and negative peritoneal cytology groups. The prognostic significance of malignant peritoneal cytology was evaluated using Cox regression, random survival forest, and subgroup analyses. RESULTS Among 733 eligible patients, 8% (59/733) had malignant peritoneal cytology, increasing to 20% (42/209) in advanced cases. Before and after propensity score matching, patients with malignant peritoneal cytology had significantly lower 5-year overall survival rates and shorter median survival time than patients with negative peritoneal cytology. Multivariate Cox regression revealed that malignant peritoneal cytology (hazard ratio 2.03, 95% confidence interval 1.29 to 3.20, p=0.002) was an independent prognostic factor for uterine leiomyosarcoma and endometrial stromal sarcoma. Random survival forest further indicated that, among the factors analyzed, peritoneal cytology status was second only to the International Federation of Gynecology and Obstetrics (FIGO) stage in terms of prognostic prediction. Finally, subgroup analyses substantiated the correlation between malignant peritoneal cytology and unfavorable overall survival in most subgroups. CONCLUSIONS Malignant peritoneal cytology status was an important prognostic factor complementing FIGO stage and was associated with a reduction in overall survival. Peritoneal cytology evaluation during hysterectomy may be recommended for prognosis estimation for uterine leiomyosarcoma and endometrial stromal sarcoma.
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Affiliation(s)
- Junhong Du
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Dan Hu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yijuan Xing
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Ruifen He
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Yuemei Cheng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Hongli Li
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Chang Liu
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Liang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yongxiu Yang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Raffone A, Raimondo D, Neola D, Travaglino A, Raspollini A, Giorgi M, Santoro A, De Meis L, Zannoni GF, Seracchioli R, Casadio P, Guida M. Diagnostic Accuracy of Ultrasound in the Diagnosis of Uterine Leiomyomas and Sarcomas. J Minim Invasive Gynecol 2024; 31:28-36.e1. [PMID: 37778636 DOI: 10.1016/j.jmig.2023.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Differential diagnosis between uterine leiomyomas and sarcomas is challenging. Ultrasound shows an uncertain role in the clinical practice given that pooled estimates about its diagnostic accuracy are lacking. OBJECTIVES To assess the accuracy of ultrasound in the differential diagnosis between uterine leiomyomas and sarcomas. DATA SOURCES A systematic review was performed searching 5 electronic databases (MEDLINE, Web of Sciences, Google Scholar, Scopus, and ClinicalTrial.gov) from their inception to June 2023. METHODS OF STUDY SELECTION All peer-reviewed observational or randomized clinical trials that reported an unbiased postoperative histologic diagnosis of uterine leiomyoma or uterine sarcoma that also comprised a preoperative ultrasonographic evaluation of the uterine mass. TABULATION, INTEGRATION, AND RESULTS Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic were calculated for each included study and as pooled estimate, with 95% confidence interval (CI); 972 women (694 with uterine leiomyomas and 278 with uterine sarcomas) were included. Ultrasound showed pooled sensitivity of 0.76 (95% CI, 0.70-0.81), specificity of 0.89 (95% CI, 0.87-0.92), positive and negative likelihood ratios of 6.65 (95% CI, 4.45-9.93) and 0.26 (95% CI, 0.07-1.0) respectively, diagnostic odds ratio of 23.06 (95% CI, 4.56-116.53), and area under the curve of 0.8925. CONCLUSIONS Ultrasound seems to have only a moderate diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas, with a lower sensitivity than specificity.
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Affiliation(s)
- Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio).
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
| | - Antonio Travaglino
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy (Dr. Travaglino)
| | - Arianna Raspollini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy (Dr. Giorgi)
| | - Angela Santoro
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy (Drs. Santoro and Zannoni)
| | - Lucia De Meis
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy (Drs. Santoro and Zannoni)
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
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18
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Lombardi A, Arezzo F, Di Sciascio E, Ardito C, Mongelli M, Di Lillo N, Fascilla FD, Silvestris E, Kardhashi A, Putino C, Cazzolla A, Loizzi V, Cazzato G, Cormio G, Di Noia T. A human-interpretable machine learning pipeline based on ultrasound to support leiomyosarcoma diagnosis. Artif Intell Med 2023; 146:102697. [PMID: 38042596 DOI: 10.1016/j.artmed.2023.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
The preoperative evaluation of myometrial tumors is essential to avoid delayed treatment and to establish the appropriate surgical approach. Specifically, the differential diagnosis of leiomyosarcoma (LMS) is particularly challenging due to the overlapping of clinical, laboratory and ultrasound features between fibroids and LMS. In this work, we present a human-interpretable machine learning (ML) pipeline to support the preoperative differential diagnosis of LMS from leiomyomas, based on both clinical data and gynecological ultrasound assessment of 68 patients (8 with LMS diagnosis). The pipeline provides the following novel contributions: (i) end-users have been involved both in the definition of the ML tasks and in the evaluation of the overall approach; (ii) clinical specialists get a full understanding of both the decision-making mechanisms of the ML algorithms and the impact of the features on each automatic decision. Moreover, the proposed pipeline addresses some of the problems concerning both the imbalance of the two classes by analyzing and selecting the best combination of the synthetic oversampling strategy of the minority class and the classification algorithm among different choices, and the explainability of the features at global and local levels. The results show very high performance of the best strategy (AUC = 0.99, F1 = 0.87) and the strong and stable impact of two ultrasound-based features (i.e., tumor borders and consistency of the lesions). Furthermore, the SHAP algorithm was exploited to quantify the impact of the features at the local level and a specific module was developed to provide a template-based natural language (NL) translation of the explanations for enhancing their interpretability and fostering the use of ML in the clinical setting.
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Affiliation(s)
- Angela Lombardi
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy.
| | - Francesca Arezzo
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Eugenio Di Sciascio
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
| | - Carmelo Ardito
- Department of Engineering, LUM "Giuseppe Degennaro" University, Casamassima, Bari, Italy
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Di Lillo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Erica Silvestris
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Carmela Putino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
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19
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Psilopatis I, Damaskos C, Garmpis N, Vrettou K, Garmpi A, Sarantis P, Koustas E, Antoniou EA, Kouraklis G, Chionis A, Kontzoglou K, Dimitroulis D. The Role of Hyperthermic Intraperitoneal Chemotherapy in Uterine Cancer Therapy. Int J Mol Sci 2023; 24:12353. [PMID: 37569726 PMCID: PMC10419250 DOI: 10.3390/ijms241512353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Endometrial cancer and uterine sarcoma represent the two major types of uterine cancer. In advanced stages, both cancer entities are challenging to treat and correlate with a meagre survival and prognosis. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a form of localized chemotherapy that is heated to improve the chemotherapeutic effect on peritoneal metastases. The aim of the current review is to study the role of HIPEC in the treatment of uterine cancer. A literature review was conducted using the MEDLINE and LIVIVO databases with a view to identifying relevant studies. By employing the search terms "hyperthermic intraperitoneal chemotherapy", "uterine cancer", "endometrial cancer", and/or "uterine sarcoma", we managed to identify 26 studies published between 2004 and 2023. The present work embodies the most up-to-date, comprehensive review of the literature centering on the particular role of HIPEC as treatment modality for peritoneally metastasized uterine cancer. Patients treated with cytoreductive surgery, alongside HIPEC, seem to profit from not only higher survival but also lower recurrence rates. Factors such as the completeness of cytoreductive surgery, the peritoneal cancer index, the histologic subtype, or the applied chemotherapeutic agent, all influence HIPEC therapy effectiveness. In summary, HIPEC seems to represent a promising treatment alternative for aggressive uterine cancer.
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Affiliation(s)
- Iason Psilopatis
- Department of Obstetrics and Gynecology, University Erlangen, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kleio Vrettou
- Department of Cytopathology, Sismanogleio General Hospital, 15126 Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Sarantis
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Koustas
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efstathios A. Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gregory Kouraklis
- Department of Surgery, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios Chionis
- Second Department of Gynecology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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20
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Coronado PJ, Alonso-Espias M, Yildirim Y, Macuks R, Mancari R, Achimas-Cadariu P, Aniorte SM, Mitidieri M, Lambaudie E, Dubois N, Zapardiel I. Lymph node dissection in uterine leiomyosarcomas: A matched-pair study. Gynecol Oncol 2023; 174:28-33. [PMID: 37146437 DOI: 10.1016/j.ygyno.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To assess the impact of the lymph node dissection (LND) in the disease-free (DFS) and overall survival (OS) of the women treated surgically of uterine leiomyosarcoma (ULMS). MATERIAL AND METHODS A multicentric retrospective study was conducted among European countries collecting patients diagnosed of uterine sarcoma (SARcoma of the UTerus - SARCUT study). A total of 390 ULMS were selected for the present study to compare patients who underwent LND and those who did not. A further matched-pair subanalysis identified 116 women, 58 pairs (58 with LND and 58 without it) comparable in age, tumor size, surgical procedures, extrauterine disease and adjuvant treatment. Demographic data, pathology results and follow-up were abstracted from medical records and analyzed. Disease-free (DFS) and overall survival (OS) were studied using Kaplan-Meier curves and Cox regression analysis. RESULTS Among the 390 patients, the 5-year DFS was significantly higher in no-LDN group comparing to the LDN group (57.7% vs. 33.0%; HR 1.75, 95% CI 1.19-2.56; p = 0.007), but not the 5-year OS (64.6% vs. 64.3%; HR 1,10 95% CI 0,77-1,79; p = 0.704). In the matched-pair subanalysis, there were no statistical differences between the study groups. The 5- year DFS was 50.5% in the no-LND and 33.0% in the LND group (HR 1.38; 95% CI 0,83-2.31; p = 0,218) and the 5-year OS was 59.7% and 64.3% respectively (HR 0.81; 95% CI 0,45-1,49; p = 0,509). CONCLUSIONS LND performed in women diagnosed of ULMS have no impact neither in the disease-free nor in the overall survival compared to patients without LDN in a complete homogeneous group.
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Affiliation(s)
- Pluvio J Coronado
- Women's Health Institute, Hospital Clínico San Carlos, IdISSC, School of Medicine, Complutense University, Madrid, Spain
| | | | | | - Ronalds Macuks
- Latvian Oncology Center of Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Rosanna Mancari
- Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, Milan; Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | | | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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21
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Zapardiel I, Gracia Segovia M, Macuks R, Mancari R, Achimas-Cadariu P, Corrado G, Bartusevicius A, Sukhin V, Muruzabal JC, Coronado Martín PJ, Gardella B, Piek JM, Concin N, Arab C, Papatheodorou D, Polterauer S, Iacoponi S, Nieto T, Lopez-Sanclemente MC, Trukhan H, Gil MM, Bakinovskaya I, Dalamanava A, Cucurull M, Rovski D, Baquedano L, Chiva L, Mardas M, Mavrichev SA, Klat J, Lopez de la Manzanara CA, Yildirim Y. Prognostic factors in patients with uterine sarcoma: the SARCUT study. Int J Gynecol Cancer 2023; 33:897-904. [PMID: 37192761 DOI: 10.1136/ijgc-2022-004204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE Uterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma. METHODS This international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007. RESULTS The 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93). CONCLUSION Incomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Ronalds Macuks
- Riga East Clinical University Hospital Latvian Oncology Center, Riga, Latvia
| | - Rosanna Mancari
- Gynecologic Oncology Department, IRCCS, Milan, Italy
- Gynecologic Oncology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patriciu Achimas-Cadariu
- Gynecologic Oncology Department, The Oncology Institute 'Prof Dr Ion Chiricuta' Cluj-Napoca, Cluj-Napoca, Romania
| | - Giacomo Corrado
- Policlinico Universitario Agostino Gemelli Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italy
| | - Arnoldas Bartusevicius
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vladyslav Sukhin
- Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine
- Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | - Juan C Muruzabal
- Gynecologic Oncology Unit, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Barbara Gardella
- Gynecologic Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jurgen M Piek
- Gynecologic Oncology Department, Catharina Hospital and Catharina Cancer Institute, Eindhoven, Netherlands
| | - Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical Univeristy, Innsbruck, Austria
- Division of General Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Clemente Arab
- Gynecologic Oncology Department, Hospital Luis Tisné. Universidad de Chile, Santiago, Chile
| | | | - Stephan Polterauer
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Teresa Nieto
- Gynecologic Oncology Department, Hospital Universitario Santa Cristina, Madrid, Spain
| | - Martha C Lopez-Sanclemente
- Gynecologic Oncology Department, Torrecárdenas Hospital Complex, Almeria, Andalucía, Spain
- Gynecologic Oncology Department, Clinica Diatros, Barcelona, Spain
| | - Hanna Trukhan
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Maria M Gil
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Irina Bakinovskaya
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Alena Dalamanava
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Marc Cucurull
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Dzmitry Rovski
- Gynecologic Oncology Department, N N Alexandrov National Cancer Center, Minsk, Belarus
| | - Laura Baquedano
- Gynecologic Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Marcin Mardas
- Department of Gynecological Oncology, Poznan University of Medical Sciences, Poznan, Wielkopolskie, Poland
| | | | - Jaroslav Klat
- Obstetrics and Gynecology Department, University Hospital Ostrava, Ostrava, Moravskoslezský, Czech Republic
| | | | - Yusuf Yildirim
- Gynecologic Oncology Department, Tepecik Training and Research Hospital Clinics, Konak, Izmir, Turkey
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22
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Khan SR, Soomar SM, Asghari T, Ahmed A, Moosajee MS. Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years' clinical experience from a tertiary care center in Pakistan. BMC Cancer 2023; 23:510. [PMID: 37277708 DOI: 10.1186/s12885-023-11000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Uterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes. METHODS A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis. RESULTS Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival. CONCLUSION Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.
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Affiliation(s)
- Saqib Raza Khan
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Tamana Asghari
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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23
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Basanoo LS, Bahall V, Mohammed S, Teelucksingh S. Metastatic Uterine Leiomyosarcoma as a Rare and Sinister Cause of Respiratory Distress: A Case Report and Literature Review. Cureus 2023; 15:e39101. [PMID: 37332439 PMCID: PMC10270647 DOI: 10.7759/cureus.39101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Uterine leiomyosarcomas are an extremely rare subtype of uterine malignancy. This is a case report of a 47-year-old woman whose underlying uterine leiomyosarcoma manifested as acute respiratory distress secondary to pulmonary metastases. We highlight that a combination of suggestive imaging features and elevated lactate dehydrogenase (LDH) may prompt its diagnosis, notwithstanding that histological examination of a tissue sample is mandatory for its confirmation. The diagnosis of this condition is arduous for a multitude of reasons, including the insidious clinical course, aggressive nature, and high propensity to metastasize, coupled with a lack of standardised guidelines for its preoperative work-up. These challenges are amplified where resources may be limited, such as in the Caribbean region, where radiographic imaging and treatment options may not always be readily available.
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Affiliation(s)
- Laéshelle S Basanoo
- Intensive Care Unit / Anaesthetic Department, Sangre Grande Hospital, Sangre Grande, TTO
| | - Vishal Bahall
- Obstetrics and Gynaecology, The University of the West Indies, St Augustine, TTO
- Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Salma Mohammed
- Intensive Care Unit / Anaesthetic Department, Sangre Grande Hospital, Sangre Grande, TTO
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24
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Psilopatis I, Vrettou K, Kokkali S, Theocharis S. The Role of MicroRNAs in Uterine Leiomyosarcoma Diagnosis and Treatment. Cancers (Basel) 2023; 15:cancers15092420. [PMID: 37173887 PMCID: PMC10177388 DOI: 10.3390/cancers15092420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Uterine sarcomas are rare gynecological tumors arising from the myometrium or the connective tissue of the endometrium with a relatively poor prognosis. MicroRNAs (miRNAs) represent small, single-stranded, non-coding RNA molecules that can function as oncogenes or tumor suppressors under certain conditions. The current review aims at studying the role of miRNAs in uterine sarcoma diagnosis and treatment. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms "microRNA" and "uterine sarcoma" were employed, and we were able to identify 24 studies published between 2008 and 2022. The current manuscript represents the first comprehensive review of the literature focusing on the particular role of miRNAs as biomarkers for uterine sarcomas. miRNAs were found to exhibit differential expression in uterine sarcoma cell lines and interact with certain genes correlating with tumorigenesis and cancer progression, whereas selected miRNA isoforms seem to be either over- or under-expressed in uterine sarcoma samples compared to normal uteri or benign tumors. Furthermore, miRNA levels correlate with various clinical prognostic parameters in uterine sarcoma patients, whereas each uterine sarcoma subtype is characterized by a unique miRNA profile. In summary, miRNAs seemingly represent novel trustworthy biomarkers for the diagnosis and treatment of uterine sarcoma.
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Affiliation(s)
- Iason Psilopatis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
- Department of Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Kleio Vrettou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
- Oncology Unit, 2nd Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
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Petrocelli R, Hindman N, Reinhold C. Current Concepts in the Imaging of Uterine Sarcomas. Radiol Clin North Am 2023; 61:627-638. [PMID: 37169428 DOI: 10.1016/j.rcl.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Uterine sarcomas are a group of rare uterine tumors comprised of multiple subtypes with different histologic characteristics, prognoses, and imaging appearances. Identification of uterine sarcomas and their differentiation from benign uterine disease on imaging is of critical importance for treatment planning to guide appropriate management and optimize patient outcomes. Herein, we review the spectrum of uterine sarcomas with a focus on the classification of primary sarcoma subtypes and presenting the typical MR imaging appearances.
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Cope BM, Traweek RS, Lazcano R, Keung EZ, Lazar AJ, Roland CL, Nassif EF. Targeting the Molecular and Immunologic Features of Leiomyosarcoma. Cancers (Basel) 2023; 15:2099. [PMID: 37046760 PMCID: PMC10093078 DOI: 10.3390/cancers15072099] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare, aggressive mesenchymal tumor with smooth muscle differentiation. LMS is one of the most common histologic subtypes of soft tissue sarcoma; it most frequently occurs in the extremities, retroperitoneum, or uterus. LMS often demonstrates aggressive tumor biology, with a higher risk of developing distant metastatic disease than most sarcoma histologic types. The prognosis is poor, particularly in patients with uterine disease, and there is a need for the development of more effective therapies. Genetically, LMS is karyotypically complex and characterized by a low tumor mutational burden, with frequent alterations in TP53, RB1, PTEN, and DNA damage response pathways that may contribute to resistance against immune-checkpoint blockade monotherapy. The LMS immune microenvironment is highly infiltrated with tumor-associated macrophages and tumor-infiltrating lymphocytes, which may represent promising biomarkers. This review provides an overview of the clinical and pathologic behavior of both soft tissue and uterine LMS and summarizes the genomic and immune characteristics of these tumors and how they may provide opportunities for the development of biomarker-based immune therapies.
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Affiliation(s)
- Brandon M. Cope
- Department of Surgery, Keesler Medical Center, Biloxi, MS 39534, USA
| | - Raymond S. Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rossana Lazcano
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alexander J. Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christina L. Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elise F. Nassif
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Pérez-Fidalgo JA, Ortega E, Ponce J, Redondo A, Sevilla I, Valverde C, Isern Verdum J, de Alava E, Galera López M, Marquina G, Sebio A. Uterine sarcomas: clinical practice guidelines for diagnosis, treatment, and follow-up, by Spanish group for research on sarcomas (GEIS). Ther Adv Med Oncol 2023; 15:17588359231157645. [PMID: 37007636 PMCID: PMC10052607 DOI: 10.1177/17588359231157645] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Uterine sarcomas are very infrequent and heterogeneous entities. Due to its rarity, pathological diagnosis, surgical management, and systemic treatment are challenging. Treatment decision process in these tumors should be taken in a multidisciplinary tumor board. Available evidence is low and, in many cases, based on case series or clinical trials in which these tumors have been included with other soft tissue sarcoma. In these guidelines, we have tried to summarize the most relevant evidence in the diagnosis, staging, pathological disparities, surgical management, systemic treatment, and follow-up of uterine sarcomas.
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Affiliation(s)
| | - Eugenia Ortega
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jordi Ponce
- Gynecology Department, Hospital Universitario de Bellvitge. IDIBELL. Universidad de Barcelona, Barcelona, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Isabel Sevilla
- Clinical and Translational Research in Cancer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional and Virgen de la Victoria de Málaga, Málaga, Spain
| | - Claudia Valverde
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Josep Isern Verdum
- Radiotherapy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique de Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Sevilla, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - Mar Galera López
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, IdISSC, Spain
- Department of Medicine, School of Medicine, Complutense University (UCM), Madrid, IdISSC, Spain
| | - Ana Sebio
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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28
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Kwolek DG, Gerstberger S, Tait S, Qiu JM. Ovarian, Uterine, and Vulvovaginal Cancers: Screening, Treatment Overview, and Prognosis. Med Clin North Am 2023; 107:329-355. [PMID: 36759101 DOI: 10.1016/j.mcna.2022.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
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Affiliation(s)
- Deborah Gomez Kwolek
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stefanie Gerstberger
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanna M Qiu
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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He X, Dong Q, Weng C, Gu J, Yang Q, Yang G. Trends in incidence, survival and initial treatments of gynecological sarcoma: a retrospective analysis of the United States subpopulation. BMC Womens Health 2023; 23:10. [PMID: 36624439 PMCID: PMC9830743 DOI: 10.1186/s12905-023-02161-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To estimate the incidence, prevalence and incidence-based mortality in patients with gynecologic sarcoma (GS), and described the trends of survival and initial treatments in the US by using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS GS cases aged 20 years or older between 1975 and 2015 were identified from SEER 9 registries. Incidence, prevalence, and incidence-based mortality were estimated, all rates were age adjusted to the 2000 US standard population and presented as per 100,000 persons. Annual percentage change (APC) and average APC (AAPC) were calculated to describe the trends. In addition, stage distribution, cancer-specific survival (CSS) and initial treatment pattern over time were also reported. RESULTS The overall age-adjusted incidence of GS increased from 2.38 to 3.41 per 100,000 persons from 1975 to 2015, with an AAPC of 1.0 (P < 0.05), and the AAPC increased to 1.3 (P < 0.05) in the last decade. The incidence of population aged ≥ 55 years was three or more times than that of population aged 20-54 year from 1975 to 2015. Corpus and uterus GS was the main subtype, and it increased significantly during last three decades (an APC of 1.5). In addition, the prevalence of corpus and uterus GS increased mostly among all GSs. The incidence of GS with regional and distant stages increased pronouncedly, but not for local stage. GS cases showed increasing 3-year and 5-year CSS rates except for other sites GS. Approximately 87.7% GS cases received surgery during the first-course treatment, but the proportion decreased over years. In contrast, the proportion of receiving multiple treatment modalities increased. CONCLUSIONS The incidence of GS increased significantly with improved survival, which might due to the strategy of combination of multiple treatment. However, no obvious improvement on the early detection of GS was found, which should be facilitated to further improve the prognosis of GS.
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Affiliation(s)
- Xi He
- Department of Obstetrics and Gynecology, The People’s Hospital of Sanjiang Dong Autonomous County, Liuzhou, 545500 China
| | - Qiang Dong
- Department of General Medicine, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Changfang Weng
- Department of Oncology, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Jianfen Gu
- Department of Clinical Nutrition, The People’s Hospital of Qijiang District, Chongqing, 401420 China
| | - Qiao Yang
- Department of Ultrasound, The 941St Hospital of the PLA Joint Logistic Support Force, Xining, 810007 China
| | - Guangrong Yang
- Department of Oncology, The People’s Hospital of Qijiang District, Chongqing, 401420 China
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Kalantri SH, Joseph LD, Priyathersini N, Elangovan B. Epithelioid leiomyosarcoma: An unusual presentation. J Cancer Res Ther 2023; 19:490-492. [PMID: 37313923 DOI: 10.4103/jcrt.jcrt_1178_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Uterine mesenchymal tumors are a heterogeneous group of neoplasms that can be diagnostically challenging. Thorough investigations and histopathological findings are highly significant to arrive at the correct diagnosis, thus ensuring appropriate and prompt treatment to the patient. Leiomyosarcoma (LMS) is an uncommon uterine malignancy, which arises from the smooth muscle of the uterine wall. They usually present in postmenopausal women with abnormal uterine bleeding. It follows an aggressive clinical course with an extremely poor prognosis. Surgical management followed by adjuvant chemotherapy is usually the treatment for such cases. Here, we report the case of a 57-year-old menopausal female who presented with a large abdominal swelling that was seen infiltrating the adjacent structures. On resection and histopathological evaluation, a diagnosis of epithelioid LMS was made, which was confirmed by immunohistochemistry.
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Affiliation(s)
- Suman H Kalantri
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Priyathersini
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Babu Elangovan
- Department of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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31
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Toyohara Y, Sone K, Noda K, Yoshida K, Kurokawa R, Tanishima T, Kato S, Inui S, Nakai Y, Ishida M, Gonoi W, Tanimoto S, Takahashi Y, Inoue F, Kukita A, Kawata Y, Taguchi A, Furusawa A, Miyamoto Y, Tsukazaki T, Tanikawa M, Iriyama T, Mori-Uchino M, Tsuruga T, Oda K, Yasugi T, Takechi K, Abe O, Osuga Y. Development of a deep learning method for improving diagnostic accuracy for uterine sarcoma cases. Sci Rep 2022; 12:19612. [PMID: 36385486 PMCID: PMC9669038 DOI: 10.1038/s41598-022-23064-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
Uterine sarcomas have very poor prognoses and are sometimes difficult to distinguish from uterine leiomyomas on preoperative examinations. Herein, we investigated whether deep neural network (DNN) models can improve the accuracy of preoperative MRI-based diagnosis in patients with uterine sarcomas. Fifteen sequences of MRI for patients (uterine sarcoma group: n = 63; uterine leiomyoma: n = 200) were used to train the models. Six radiologists (three specialists, three practitioners) interpreted the same images for validation. The most important individual sequences for diagnosis were axial T2-weighted imaging (T2WI), sagittal T2WI, and diffusion-weighted imaging. These sequences also represented the most accurate combination (accuracy: 91.3%), achieving diagnostic ability comparable to that of specialists (accuracy: 88.3%) and superior to that of practitioners (accuracy: 80.1%). Moreover, radiologists' diagnostic accuracy improved when provided with DNN results (specialists: 89.6%; practitioners: 92.3%). Our DNN models are valuable to improve diagnostic accuracy, especially in filling the gap of clinical skills between interpreters. This method can be a universal model for the use of deep learning in the diagnostic imaging of rare tumors.
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Affiliation(s)
- Yusuke Toyohara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | | | | | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoya Tanishima
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shimpei Kato
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Saki Tanimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yu Takahashi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Futaba Inoue
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Asako Kukita
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoshiko Kawata
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Akiko Furusawa
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takehiro Tsukazaki
- Department of Obstetrics and Gynecology, Showa General Hospital, Tokyo, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Mayuyo Mori-Uchino
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Katsutoshi Oda
- Division of Integrative Genomics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiharu Yasugi
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kimihiro Takechi
- Department of Obstetrics and Gynecology, Showa General Hospital, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
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Nucci MR, Webster F, Croce S, George S, Howitt BE, Ip PPC, Lee CH, Rabban JT, Soslow RA, van der Griend R, Lax SF, McCluggage WG. Data Set for Reporting of Uterine Malignant and Potentially Malignant Mesenchymal Tumors: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S44-S63. [PMID: 36305534 DOI: 10.1097/pgp.0000000000000911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) seeks to produce standardized, evidence-based protocols for the reporting of tumors with the aim of ensuring that all cancer reports generated worldwide will be of similar high quality and record the same elements. Herein, we describe the development of the data set for the reporting of uterine malignant and potentially malignant mesenchymal tumors by a panel of expert pathologists and a single clinician and provide the commentary and rationale for the inclusion of core and noncore elements. This data set, which incorporates the recent updates from the 5th edition of the World Health Organization Classification of Female Genital Tumors, addresses several subjects of debate including which mesenchymal tumors should be graded, how to document extent of invasion, mitotic counts, and the role of ancillary testing in tumor diagnosis and patient management. The inclusion of elements is evidence-based or based on consensus of the expert panel with clinical relevance being the guiding standard.
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Maia Falcão R, Kokaraki G, De Wispelaere W, Amant F, De Souza GA, de Souza JES, Carlson JW, Petta TB. The Expression of the Immunoproteasome Subunit PSMB9 Is Related to Distinct Molecular Subtypes of Uterine Leiomyosarcoma. Cancers (Basel) 2022; 14:cancers14205007. [PMID: 36291793 PMCID: PMC9600211 DOI: 10.3390/cancers14205007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Uterine leiomyosarcoma (uLMS) is a rare, aggressive, and highly heterogeneous tumor. Knockout female mice for the catalytic subunit of the immunoproteasome PSMB9 develops spontaneous uLMS. In this study, we used molecular data from 3 non-related uLMS cohorts that were integrated and analyzed by proteotranscriptomics. We observed overexpression of the immunoproteasome pathway in uLMS, and then further classified the samples as low or high PSMB9 gene expression levels and we provide evidence that; (i) in the group high there is an enrichment of pathways related to the immune system and in the group low, the ECM formation; (ii) samples with high CD8+/PSMB9 ratio shows better OS; and (iii) the main regulator in the high group is IFNγ and in the low, the proto-oncogene SRC. These findings contribute to the understanding of potential therapeutic or prognostic markers in uLMS. Abstract Background: Uterine leiomyosarcoma (uLMS) are rare and malignant tumors that arise in the myometrium cells and whose diagnosis is based on histopathological features. Identifying diagnostic biomarkers for uLMS is a challenge due to molecular heterogeneity and the scarcity of samples. In vivo and in vitro models for uLMS are urgently needed. Knockout female mice for the catalytic subunit of the immunoproteasome PSMB9 (MIM:177045) develop spontaneous uLMS. This study aimed to analyze the role of PSMB9 in uLMS tumorigenesis and patient outcome. Methods: Molecular data from 3 non-related uLMS cohorts were integrated and analyzed by proteotranscriptomic using gene expression and protein abundance levels in 68 normal adjacent myometrium (MM), 66 uterine leiomyoma (LM), and 67 uLMS. Results: the immunoproteasome pathway is upregulated and the gene PMSB9 shows heterogeneous expression values in uLMS. Quartile group analysis showed no significant difference between groups high and low PSMB9 expression groups at 3-years overall survival (OS). Using CYBERSORTx analysis we observed 9 out of 17 samples in the high group clustering together due to high M2 macrophages and CD4 memory resting, and high CD8+/PSMB9 ratio was associated with better OS. The main pathway regulated in the high group is IFNγ and in the low is the ECM pathway dependent on the proto-oncogene SRC. Conclusion: these findings suggest 2 subtypes of uLMS (immune-related and ECM-related) with different candidate mechanisms of malignancy.
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Affiliation(s)
- Raul Maia Falcão
- Bioinformatics Graduate Program, Instituto Metropole Digital, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
- University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Georgia Kokaraki
- University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Wout De Wispelaere
- Department of Oncology, Leuven and Leuven Cancer Institute, Katholieke Universiteit, 3000 Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, Leuven and Leuven Cancer Institute, Katholieke Universiteit, 3000 Leuven, Belgium
- Department of Surgery, The Netherlands Cancer Institute, 1066 Amsterdam, The Netherlands
| | - Gustavo Antônio De Souza
- Bioinformatics Graduate Program, Instituto Metropole Digital, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | - Jorge Estefano Santana de Souza
- Bioinformatics Graduate Program, Instituto Metropole Digital, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
- University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Joseph Woodward Carlson
- University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
- K7 Onkologi-Patologi, Karolinska Institute, 17177 Stockholm, Sweden
| | - Tirzah Braz Petta
- Bioinformatics Graduate Program, Instituto Metropole Digital, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
- University of Southern California Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
- K7 Onkologi-Patologi, Karolinska Institute, 17177 Stockholm, Sweden
- Correspondence: ; Tel.: +1-323-442-1153
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Lee JS, Kelly CM, Bartlett EK. Management of pelvic sarcoma. Eur J Surg Oncol 2022; 48:2299-2307. [PMID: 36195471 DOI: 10.1016/j.ejso.2022.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
Pelvic sarcomas are a rare and heterogenous group of tumors divided into two groups: soft tissue sarcomas and bone sarcomas. Soft tissue sarcomas of the pelvis include most commonly liposarcoma, leiomyosarcoma, gastrointestinal stromal tumors, malignant peripheral nerve sheath tumors, and solitary fibrous tumors. Bone sarcomas of the pelvis most commonly include osteosarcoma and chondrosarcoma. Multidisciplinary treatment at a center experienced in the treatment of sarcoma is essential. Management is dictated by histologic type and grade. Surgical resection with wide margins is the cornerstone of treatment for pelvic sarcomas, although this is often challenging due to anatomic constraints of the pelvis. Multimodal treatment is critical due to the high risk of local recurrence in the pelvis.
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Affiliation(s)
- Jay S Lee
- Department of Surgery, Duke University, Durham, NC, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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35
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Huang X, Peng P. Hormone Therapy Reduces Recurrence in Stage II-IV Uterine Low-Grade Endometrial Stromal Sarcomas: A Retrospective Cohort Study. Front Oncol 2022; 12:922757. [PMID: 35837098 PMCID: PMC9275776 DOI: 10.3389/fonc.2022.922757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Low-grade endometrial stromal sarcoma (LG-ESS) is a rare and indolent malignancy. Hormone therapy has been reported as an adjuvant treatment for LG-ESS, although its effectiveness is controversial. Here we aimed to investigate the effects of postoperative hormone therapy on recurrence in patients with uterine LG-ESS. Between January 2010 and December 2019, a total of 152 patients (23 with and 129 without fertility-sparing) with a diagnosis of primary uterine LG-ESS confirmed by pathologists were enrolled in this study. In the cohort without fertility-sparing, 22 (17.7%) patients had recurrence, and the median disease-free survival (DFS) was 47 (2-130) months; only one of these patients died of LG-ESS. No significant difference was found in recurrence between the groups with and without hormone therapy (p=0.802). However, subgroup analysis showed that hormone therapy decreased the recurrence rate in stage II-IV (p=0.001, HR 0.144, 95% CI: 0.038-0.548), but not in stage I disease (p=0.256). High-dose progestins notably reduced recurrence (p=0.012, HR 0.154, 95% CI: 0.036-0.660), whereas non-progestin therapy marginally influenced recurrence (p=0.054) compared with no hormone therapy in stage II-IV disease. Moreover, hormone therapy within 12 months was effective in reducing recurrence (p=0.038, HR 0.241, 95% CI: 0.063-0.922). Ovarian preservation (p=0.004, HR 6.250, 95% CI: 1.786-21.874) and negative expression of ER/PR (p=0.000, HR 23.249, 95% CI: 4.912-110.026) were high-risk factors for recurrence in patients without fertility-sparing. In the fertility-sparing cohort, 15 (65.2%) patients experienced recurrence, and the median DFS was 24 (3-107) months. Six patients successfully delivered healthy fetuses, and five received hormone therapy. Twelve patients finally accepted hysterectomy after repeated recurrence, and only two of them had given birth before surgery. Patients who received hormone therapy showed longer DFS, although this difference was not statistically significant (p=0.466). In conclusion, postoperative hormone therapy reduces recurrence in patients with stage II–IV uterine LG-ESS without fertility-sparing, and high-dose treatment with progestins within 12 months is recommended. Bilateral oophorectomy can also reduce the risk of recurrence. Patients with fertility-sparing have a high risk of recurrence and poor pregnancy outcomes, and hormone therapy may be a reasonable choice in postoperative management.
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Li YJ, Lyu J, Li C, He HR, Wang JF, Wang YL, Fang J, Ji J. A novel nomogram for predicting cancer-specific survival in women with uterine sarcoma: a large population-based study. BMC Womens Health 2022; 22:175. [PMID: 35568940 PMCID: PMC9107666 DOI: 10.1186/s12905-022-01739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine sarcoma (US) is a rare malignant uterine tumor with aggressive behavior and rapid progression. The purpose of this study was to constructa comprehensive nomogram to predict cancer-specific survival (CSS) of patients with US-based on the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A retrospective population-based study was conducted using data from patients with US between 2010 and 2015 from the SEER database. They were randomly divided into a training cohort and a validation cohort ata 7-to-3 ratio. Multivariate Cox analysis was performed to identify independent prognostic factors. Subsequently, a nomogram was established to predict patient CSS. The discrimination and calibration of the nomogram were evaluated by the concordance index (C-index) and the area under the curve (AUC). Finally, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA) were used to evaluate the benefits of the new prediction model. RESULTS A total of 3861 patients with US were included in our study. As revealed in multivariate Cox analysis, age at diagnosis, race, marital status, insurance record, tumor size, pathology grade, histological type, SEER stage, AJCC stage, surgery status, radiotherapy status, and chemotherapy status were found to be independent prognostic factors. In our nomogram, pathology grade had strongest correlation with CSS, followed by age at diagnosis and surgery status. Compared to the AJCC staging system, the new nomogram showed better predictive discrimination with a higher C-index in the training and validation cohorts (0.796 and 0.767 vs. 0.706 and 0.713, respectively). Furthermore, the AUC value, calibration plotting, NRI, IDI, and DCA also demonstrated better performance than the traditional system. CONCLUSION Our study validated the first comprehensive nomogram for US, which could provide more accurate and individualized survival predictions for US patients in clinical practice.
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Affiliation(s)
- Yuan-Jie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiao Tong University Health Science Center, Xi'an, Shaanxi, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Chen Li
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hai-Rong He
- Department of Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jin-Feng Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yue-Ling Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jing Fang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jing Ji
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Mayr D, Horn LC, Hiller GGR, Höhn AK, Schmoeckel E. [Endometrial and other rare uterine sarcomas : Diagnostic aspects in the context of the 2020 WHO classification]. DER PATHOLOGE 2022; 43:183-195. [PMID: 35362728 DOI: 10.1007/s00292-022-01072-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Uterine sarcomas are a heterogeneous group of rare malignancies. Mostly (40-50%), they are leiomyosarcomas, followed by endometrial stromal sarcomas (ESS), low-grade (LG) and high-grade (HG), as well as undifferentiated sarcoma of the uterus (UUS) and adenosarcomas (AS). Other, non-organ-specific tumours such as NTRK-rearranged spindle cell neoplasia, perivascular epithelioid cell tumour (PEComa) and inflammatory myofibroblastic tumour (IMT) are extremely difficult to differentiate.In the most recent WHO classification, endometrial stromal tumours are subdivided as follows: benign, expansively growing endometrial stromal nodule (ESN) with sharp demarcation, the histologically similar-looking LG-ESS with infiltrative growth, the highly malignant HG-ESS and, as a diagnosis of exclusion, the highly aggressive UUS lacking specific lines of differentiation. LG-ESS can be differentiated from HG-ESS in most cases histomorphologically and immunohistochemically, but molecular investigations are necessary in individual cases. HG-ESS can be divided into 4 subtypes (YWHAE/NUTM2 fusion low-grade component, YWHAE/NUTM2 fusion high-grade component, ZC3H7B-BCOR fusion or BCOR-ITD) on the basis of molecular findings. Prognostically unfavourable factors in AS are severe sarcomatous overgrowth, deep myometrial invasion, high-grade histology and lymphatic vessel invasion. Tumours with NTRK fusion are immunohistochemically positive for S100 and TRK. PEComas express cathepsin K and HMB45, as well as TFE3 when translocation is present. Almost every IMT shows an alteration in the ALK gene In the case of overlapping morphology and simultaneous therapeutic and prognostic relevance, it is becoming increasingly important to verify or confirm the suspected histomorphological diagnosis by immunohistochemical and possibly molecular investigations.
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Affiliation(s)
- Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland.
| | - Lars-Christian Horn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | | | - Anne Kathrin Höhn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland
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Roy M, Musa F, Taylor SE, Huang M. Uterine Sarcomas: How to Navigate an Ever-Growing List of Subtypes. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35471831 DOI: 10.1200/edbk_350955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Uterine sarcomas are rare mesenchymal tumors that are aggressive cancers. The rarity of these tumors, and consequently limited prospective data, has made surgical management of uterine sarcomas challenging. One major obstacle in the management of uterine sarcomas is establishing the diagnosis prior to surgery, which is crucial for appropriate intraoperative management. This paper serves to review aspects of surgical management of uterine sarcomas that remain unanswered. Distinguishing common benign myomas from rare uterine sarcomas is important for operative planning and subspecialty care because benign myomas are frequently managed with minimally invasive hysterectomy or myomectomy, whereas the mainstay of management of uterine sarcomas is hysterectomy without specimen fragmentation. Preoperative clinical presentation, serum studies, imaging, and histologic examination all have limitations in establishing a preoperative diagnosis. In addition, patients are often of reproductive age and desire fertility preservation. Although surgery remains the cornerstone for management, high-quality data guiding best practices are sparse. Morcellation should be avoided. Expert pathologic review, imaging to assess for metastatic disease, and consideration of hormone receptor testing are advisable. Recent data have further informed surgical approach and fertility preservation in early-stage disease, but controversy remains. Despite substantial advancement in the medical management of uterine sarcomas, surgical management of uterine sarcomas remain challenging. Larger studies with long-term follow-up are needed to guide fertility preservation surgery options, both local resection and ovarian preservation, further in young women. Development of novel methods to differentiate between benign and malignant uterine masses is needed.
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Affiliation(s)
- Molly Roy
- Sylvester Comprehensive Center Cancer/University of Miami Miller School of Medicine, Miami, FL
| | | | | | - Marilyn Huang
- Sylvester Comprehensive Center Cancer/University of Miami Miller School of Medicine, Miami, FL
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Huang Y, Lin Y, Li Y, Chu K, Zhou Y, Lin L, Zhou R, Zhang Z, Lin Q. Adjuvant radiotherapy shows benefit in selected stage I uterine sarcoma: A risk scoring system based on a population analysis. Cancer Med 2022; 11:2846-2854. [PMID: 35277934 PMCID: PMC9302311 DOI: 10.1002/cam4.4643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background The potential therapeutic benefit of adjuvant radiotherapy for patients with stage I uterine sarcoma has not been clear. In this study, we aimed to develop a risk scoring model to select the subgroup of patients with stage I uterine sarcoma who might benefit from adjuvant radiotherapy. Methods Patients with stage I uterine sarcoma from the Surveillance, Epidemiology, and End Results program from 2010 to 2014 were retrospectively included in this analysis. Cox proportional hazards models were performed to identify risk factors. Results A total of 947 stage I uterine sarcoma patients were included. The 5‐year disease‐specific survival (DSS) of the overall cohort was 75.81%. Multivariate analysis identified stage (p = 0.013), tumor grade (p <0.001) and histology (p = 0.043) as independent prognostic factors for DSS, and these factors were used to generate the risk scoring model. The low‐risk group presented a better DSS than the high‐risk group (95.51% vs. 49.88%, p < 0.001). The addition of radiotherapy to surgery significantly increased the DSS in the high‐risk group compared with surgery alone (78.06% vs. 46.88%, p = 0.022), but no significant survival benefit was observed in the low‐risk group (98.36% vs. 100%, p = 0.766). Conclusions Our risk scoring model based on stage, tumor grade, and histology predicted the outcome of patients with stage I uterine sarcoma cancer. This system may help to select stage I uterine sarcoma cancer patients who might benefit from adjuvant radiotherapy.
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Affiliation(s)
- Yun‐xia Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yan‐zong Lin
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yi‐min Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Ke‐xin Chu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yu‐fei Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Li‐mei Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Rui Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Zong‐kai Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Qin Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
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Uterine Sarcoma: Retrospective Study From A Single institute. J Obstet Gynaecol India 2022; 72:306-312. [PMID: 35928081 PMCID: PMC9343530 DOI: 10.1007/s13224-021-01612-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Abstract Uterine sarcomas are heterogeneous group of tumours comprising 1% of gynaecological malignancies. There is lack of concences on optimal treatment of uterine sarcomas. This is because of lack of randomised controlled trials due to rarity of these tumours. Surgical management without spill remains the standard primary treatment. Most of the times uterine sarcomas are diagnosed postoperatively from histopathology report of either myomectomy or hysterectomy. This retrospective study analysed the clinico pathological characteristics, prognostic factors, treatment details and survival outcome of different types of uterine sarcomas. Materials and methods This is a retrospective analysis of 59 patients of uterine sarcomas. All patients underwent surgery. Adjuvant chemotherapy or radiation treatment were given according to histopathological report and FIGO stage. Patients were followed up every three months for first two years and then every six months. Disease free survival (DFS) and Overall survival (OS) were calculated. Statistical analysis The data were summarized using descriptive statistics as mean, percent and range. Survival probabilities were estimated using Kaplan-Meier method and the significance of difference between the survival curves were calculate using log-rank test. Results Uterine sarcomas are rare and aggressive tumours of uterus. Majority of these tumours present in early stage. Surgery remains the main treatment modality. Role of adjuvant radiation treatment remains controversial. Tumour stage is the most important prognostic factor.
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Maccaroni E, Lunerti V, Agostinelli V, Giampieri R, Zepponi L, Pagliacci A, Berardi R. New Insights into Hormonal Therapies in Uterine Sarcomas. Cancers (Basel) 2022; 14:921. [PMID: 35205669 PMCID: PMC8870116 DOI: 10.3390/cancers14040921] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
Uterine sarcoma (US) is a rare mesenchymal malignant cancer type, accounting for 3-7% of uterine malignancies. US prognosis is still poor due to high local and distant recurrence rates. As for molecular features, US may present variable oestrogen receptor (ER) and progesterone receptor (PR) expressions, mostly depending on histotype and grading. Surgery represents the mainstay of treatment for early-stage disease, while the role of adjuvant chemotherapy or local radiotherapy is still debated and defined on the basis of histotype, tumour grading and stage. In metastatic setting, uterine sarcomas' treatment includes palliative surgery, a metastases resection, chemotherapy, hormonal therapy and targeted therapy. As for the chemotherapy regimen used, drugs that are considered most effective are doxorubicin (combined with ifosfamide or alone), gemcitabine combined with docetaxel and, more recently, trabectedin or pazopanib. Hormonal therapies, including aromatase inhibitors (AIs), progestins and gonadotropin-releasing hormone analogues (GnRH-a) may also represent an effective option, in particular for low-grade endometrial stromal sarcoma (LGESS), due to their favourable toxicity profile and patients' compliance, while their role is still under investigation in uterine leiomyosarcoma (uLMS), high-grade endometrial stromal sarcoma (HGESS), undifferentiated uterine sarcoma (USS) and other rarer US. The present review aims to analyse the existing evidence and future perspectives on hormonal therapies in US, in order to clarify their potential role in daily clinical practice.
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Affiliation(s)
- Elena Maccaroni
- Department of Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.Z.); (A.P.)
| | - Valentina Lunerti
- Department of Oncology, Università Politecnica delle Marche, 60126 Ancona, Italy; (V.L.); (V.A.)
| | - Veronica Agostinelli
- Department of Oncology, Università Politecnica delle Marche, 60126 Ancona, Italy; (V.L.); (V.A.)
| | - Riccardo Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.G.); (R.B.)
| | - Laura Zepponi
- Department of Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.Z.); (A.P.)
| | - Alessandra Pagliacci
- Department of Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.Z.); (A.P.)
| | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.G.); (R.B.)
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Chantasartrassamee P, Kongsawatvorakul C, Rermluk N, Charakorn C, Wattanayingcharoencha R, Lertkhachonsuk AA. Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study. Eur J Obstet Gynecol Reprod Biol 2022; 270:176-180. [DOI: 10.1016/j.ejogrb.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
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Li K, Yin R, Li L, Wang D, Li L, Ma C, Ren Q, Wang G, Fan Y, Zhou H, Liu Z, Li T, Luo K, Kui D, Wang J. Diagnosis and treatment of uterine sarcoma: A multicenter, real-world study in western China. Medicine (Baltimore) 2021; 100:e28220. [PMID: 34941084 PMCID: PMC8702065 DOI: 10.1097/md.0000000000028220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
A detailed understanding of the diagnosis and treatment of uterine sarcoma in the real world is required due to its low incidence, high malignancy, lack of specific symptoms, and lack of high-level evidence supporting its clinical diagnosis and treatment. This study aimed to provide a basis for the standardized diagnosis and treatment of uterine sarcoma. It retrospectively analyzed the real-world data on the diagnosis, treatment, and prognosis of uterine sarcoma in western China.The clinical and pathological data of patients with uterine sarcoma diagnosed and treated between January 2009 and January 2019 in 13 medical centers from 4 western provinces of China, Sichuan, Guangxi, Shaanxi, and Xinjiang, were collected and further examined by univariate and multivariate analyses to find possible risk factors affecting the prognosis of uterine sarcoma.A total of 299 patients with various pathological types of uterine sarcoma were included, with an average age of 47.7 ± 11.1 years. The univariate and multivariate analyses showed that age (P = .0081), family history (P = .0358), and chemotherapy regimen (P = .0005) significantly correlated with progression-free survival; while age (P = .0393) and International Federation of Gynecology and Obstetrics staging (P = .0141) significantly correlated with overall survival.As age increased, the risk of death in patients with uterine sarcoma increased; The disease tended to progress faster in lower-age patients. A family history of tumors had an impact on disease progression; however, the way in which it affected needs further exploration. Different chemotherapy regimens affected the patient's disease progression. This study suggested that the anthracycline chemotherapy regimen was slightly better.
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Affiliation(s)
- Kemin Li
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Rutie Yin
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Li
- Hospital Affiliated to Guangxi Medical University, Nanling, China
| | - Danqing Wang
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Li
- Tumor Hospital Affiliated to Xinjiang Medical University, Xingjiang, China
| | - Cailing Ma
- The First Affiliated Hospital of Xinjiang Medical University, Xingjiang, China
| | - Qianchuan Ren
- The Affiliated Hospital of Southwest Medical University, Luozhou, China
| | - Guqing Wang
- Shaanxi Provincial Cancer Hospital, Xian, China
| | - Yang Fan
- NingXia people's Hospital, Yinchuan, China
| | - Honggui Zhou
- Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Zi Liu
- The First Affiliated Hospital of Xi’an Jiaotong University, Xian, China
| | - Tao Li
- The Third People‘s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Kunrong Luo
- The Second Hospital of Liangshan Yi State, Sichuan Province, Sichuan, China
| | - Dingqing Kui
- Dazhou Central Hospital, Sichuan Province, Sichuan, China
| | - Jingyi Wang
- Department of Obstetric and Gynecology, The Second Affiliate Hospital of Chengdu Medical College, China National Corporation 416 Hospital, Sichuan, China
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Sousa FAE, Ferreira J, Cunha TM. MR Imaging of uterine sarcomas: a comprehensive review with radiologic-pathologic correlation. Abdom Radiol (NY) 2021; 46:5687-5706. [PMID: 34468798 DOI: 10.1007/s00261-021-03263-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
The aim of this article is to summarize the MRI features of each sarcoma subtype and to correlate them with its pathological findings. Literature review through PubMed/Medline database to identify relevant articles on uterine sarcomas, with a special emphasis on their MRI findings and pathological features. While several, more generalistic, MRI findings of a uterine tumour should raise suspicion for malignancy (including irregular contour, intra-tumoral necrosis/hemorrhage and low ADC values), some particular features may suggest their specific histological subtype such as the gross lymphovascular invasion associated with endometrial stromal sarcomas, the "bag of worms" appearance of the low-grade endometrial stromal sarcoma and the "lattice-like" aspect of adenosarcomas which results from the mixed composition of solid and multiseptated cystic components. Knowledge of the different histological uterine sarcoma subtypes, their specific MRI features and comprehension of their pathological background allows for a more confident diagnosis and may indicate the correct histological subtype.
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Affiliation(s)
- Filipa Alves E Sousa
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisbon, Portugal.
| | - Joana Ferreira
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
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Sadeghi N, Addley S, Alazzam M, Traill Z, Johnson CA, McCole M, Soleymani Majd H. Intravascular leiomyomatosis; mimicking low grade endometrial sarcoma. J OBSTET GYNAECOL 2021; 42:1564-1568. [PMID: 34749572 DOI: 10.1080/01443615.2021.1963220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Negin Sadeghi
- Obstetrics and Gynaecology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Susan Addley
- Gynaecology Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Moiad Alazzam
- Gynaecology Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Zoe Traill
- Radiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Catherine A Johnson
- Radiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Mark McCole
- Pathology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Hooman Soleymani Majd
- Gynaecology Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
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Wang Q, Wu X, Zhu X, Wang J, Xu F, Lin Z, Gong C, He M, Zhang L. MRI features and clinical outcomes of unexpected uterine sarcomas in patients who underwent high-intensity focused ultrasound ablation for presumed uterine fibroids. Int J Hyperthermia 2021; 38:39-45. [PMID: 34420442 DOI: 10.1080/02656736.2021.1921288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the MRI features and clinical outcomes of unexpected uterine sarcomas in patients after high-intensity focused ultrasound (HIFU) ablation for presumed uterine fibroids. MATERIALS AND METHODS 15,759 consecutive patients who came for HIFU treatment, from November 2008 to September 2019, for presumed uterine fibroids were retrospectively reviewed. All the patients had completed a pre-HIFU MRI. All MRI images were independently analyzed and interpreted by two radiologists in every center. RESULTS According to the T2WI MRI features of hyperintensity, accompanied by irregular margins, necrosis or cystic degeneration, multi-lobulated lesion with internal septation, 46 patients were suspected to be uterine sarcomas before HIFU. Eleven patients were histologically diagnosed as uterine sarcomas after laparotomy. Among the 15713 patients who received HIFU treatment for presumed uterine fibroids, 8 patients were found to have occult recurrence during the follow-up period, and 6 were confirmed histologically as uterine sarcomas after laparotomy. The incidence rate of uterine sarcomas was 0.108% (17/15759). Among them, 12 cases were low-grade endometrial stromal sarcoma (LG-ESS) and 5 cases were uterine leiomyosarcoma (LMS). No histological dissemination of the sarcoma was detected in patients with unexpected uterine sarcomas. CONCLUSION Although some MRI features of uterine sarcomas and uterine fibroids overlapped, MRI is valuable in distinguishing between uterine fibroids and uterine sarcomas. HIFU does not seem to cause histological dissemination of the sarcoma, but follow-up visits should be strictly adhered to in order to detect unexpected uterine sarcomas at an early stage and to treat them in a timely manner.
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Affiliation(s)
- Qian Wang
- Chongqing Haifu Hospital, Chongqing, China.,State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xiuying Wu
- Yongchuan Maternal and Child Health Care Hospital of Chongqing, Chongqing, China
| | - Xiaogang Zhu
- Department of Gynaecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jian Wang
- Chongqing Haifu Hospital, Chongqing, China.,Department of Gynaecology, Three Gorges Central Hospital of Chongqing, Chongqing, China
| | - Feng Xu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhenjiang Lin
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Chunmei Gong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Min He
- Chongqing Haifu Hospital, Chongqing, China.,State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Abu-Rustum NR, Yashar CM, Bradley K, Campos SM, Chino J, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Diver E, Fisher CM, Frederick P, Gaffney DK, George S, Giuntoli R, Han E, Howitt B, Huh WK, Lea J, Mariani A, Mutch D, Nekhlyudov L, Podoll M, Remmenga SW, Reynolds RK, Salani R, Sisodia R, Soliman P, Tanner E, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Motter AD. NCCN Guidelines® Insights: Uterine Neoplasms, Version 3.2021. J Natl Compr Canc Netw 2021; 19:888-895. [PMID: 34416706 DOI: 10.6004/jnccn.2021.0038] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The NCCN Guidelines for Uterine Neoplasms provide recommendations for diagnostic workup, clinical staging, and treatment options for patients with endometrial cancer or uterine sarcoma. These NCCN Guidelines Insights focus on the recent addition of molecular profiling information to aid in accurate diagnosis, classification, and treatment of uterine sarcomas.
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Affiliation(s)
| | | | | | | | | | | | | | - David Cohn
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | | | - Edward Tanner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Renata Urban
- Fred Hutchinson Cancer Research CenterSeattle Cancer Care Alliance
| | | | | | - Kristine Zanotti
- Case Comprehensive Cancer CenterUniversity Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; and
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48
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Essential Oils, Pituranthos chloranthus and Teucrium ramosissimum, Chemosensitize Resistant Human Uterine Sarcoma MES-SA/Dx5 Cells to Doxorubicin by Inducing Apoptosis and Targeting P-Glycoprotein. Nutrients 2021; 13:nu13051719. [PMID: 34069490 PMCID: PMC8160977 DOI: 10.3390/nu13051719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 01/02/2023] Open
Abstract
The multidrug resistance phenotype is a global phenomenon and causes chemotherapy failure in various cancers, such as in uterine sarcomas that have a high mortality rate. To overcome this phenotype, there is growing research interest in developing new treatment strategies. In this study, we highlight the potential of two essential oils from the Apiaceae family, Pituranthos chloranthus (PC) and Teucrium ramosissimum Desf. (TR), to act as chemopreventive and chemosensitizing agents against two uterine sarcoma cell lines, MES-SA and P-gp-overexpressing MES-SA/Dx5 cells. We found that PC and TR were able to inhibit the cell viability of sensitive MES-SA and resistant MES-SA/Dx5 cells by a slight modulation of the cell cycle and its regulators, but also through a significant induction of apoptosis. The molecular mechanism involved both caspase pathways associated with an overproduction of reactive oxygen species (ROS) and mitochondrial membrane depolarization. Very interestingly, the combination of doxorubicin with PC or TR induced a synergism to increase cell death in resistant MES-SA/Dx5 cells and, subsequently, had the benefit of decreasing the resistance index to doxorubicin. These synergistic effects were reinforced by a decrease in P-gp expression and its P-gp adenosine triphosphatase (ATPase) activity, which subsequently led to intracellular doxorubicin accumulation in resistant sarcoma cells.
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Baa AK, Rastogi S, Tripathy S, Shamim SA, Menon S. Unfolding the rarity of SMARCA4 deficient uterine sarcoma (SDUS): A case report. Gynecol Oncol Rep 2021; 37:100788. [PMID: 34095424 PMCID: PMC8167214 DOI: 10.1016/j.gore.2021.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
SMARCA4 deficient Uterine sarcoma is a rare but highly aggressive sarcoma. Diagnostic dilemma is the major hurdle. Germline testing warranted to identify hereditary syndrome (RTPS). Established chemotherapeutic guidelines for SDUS is sparse. Gemcitabine-taxol based regimen yielded significant clinic-radiological benefit. Background SMARCA4 deficient uterine sarcoma (SDUS) is a relatively new entity added to the family of uterine sarcoma characterised by SMARCA4/BRG1 deficiency. Case A 62 years old lady presented with abdominal pain and vaginal discharge. On evaluation, found to have a pelvic mass with lymph nodal involvement. She underwent hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy. Preliminary diagnosis made outside was endometrial stromal sarcoma. On further review, had epithelioid and rhabdoid morphology with SMARCA4 loss documented on comprehensive gene profiling. Recurrence within few months of surgery was seen. She was started on gemcitabine and taxol based chemotherapy, showing significant clinical and radiological improvement. Conclusion Diagnostic dilemma of this infrequent, aggressive subtype of uterine sarcoma adds to the hindrance in early recognition. Identifying histology surmounted with gene profiling is helpful in establishing diagnosis resulting in early treatment and improving outcomes.
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Affiliation(s)
- Annie Kanchan Baa
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarthak Tripathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
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50
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Dai Q, Xu B, Wu H, You Y, Wu M, Li L. The prognosis of recurrent low-grade endometrial stromal sarcoma: a retrospective cohort study. Orphanet J Rare Dis 2021; 16:160. [PMID: 33827628 PMCID: PMC8028754 DOI: 10.1186/s13023-021-01802-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background The prognosis of recurrent low-grade endometrial stromal sarcoma (LGESS) is little known. This study was to investigate the survival outcomes of a cohort of patients with recurrent LGESS. Methods Patients with primary LGESS diagnosed and treated for first recurrence confirmed by histology in the study center from February 2012 to June 2019 were retrospectively included. The progression-free interval (PFI) after the last treatment for first recurrence and overall survival (OS) since the diagnosis of first recurrence, which were followed up to June 1, 2020, were compared between groups of various therapy modalities. Results Fifty-six patients were included, and 43 patients (76.8%) had definite follow-up outcomes. The 5-year PFI and OS rates were 30.0% (95% confidence interval [95% CI] 29.2–30.8) and 75.0% (68.0–82.0), respectively. In univariate analysis, only fertility-sparing treatment, ovarian preservation and surgical treatment had a significant impact on the PFI (hazard ratio [HR] 4.5, 3.1, and 0.2; 95% CI 1.5–13.1, 1.3–7.3, and 0.1–0.7; and p = 0.006, 0.009 and 0.006, respectively), but no factor was found to be associated with increased mortality risk. After adjusted with hormone treatment or chemotherapy, surgical treatment had significant effectiveness on OS (HR 0.3 and 0.3, 95% CI 0.1–1.0 and 0.1–1.0, p = 0.045 and 0.049, respectively). None of the patients with fertility-sparing treatment had successful conception, and all experienced repeated relapse. Conclusion For patients with recurrent LGESS, fertility-sparing treatment or ovarian preservation should not be provided. Surgery is the treatment of choice, and hormone treatment and/or chemotherapy was effective for the survival benefits of surgical treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01802-8.
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Affiliation(s)
- Qianwen Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Baolin Xu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.,Department of Obstetrics and Gynecology, the Second People's Hospital of Jingdezhen, Jingdezhen, 333099, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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