Presentation is loading. Please wait.

Presentation is loading. Please wait.

L ONG TERM OUTCOMES OF PATIENTS WITH LEIOMYOSARCOMA OF UTERINE VS. EXTRA - UTERINE ORIGIN Srikanth Divi, Medical Student, Univ. of Pittsburgh Meghan Levy,

Similar presentations


Presentation on theme: "L ONG TERM OUTCOMES OF PATIENTS WITH LEIOMYOSARCOMA OF UTERINE VS. EXTRA - UTERINE ORIGIN Srikanth Divi, Medical Student, Univ. of Pittsburgh Meghan Levy,"— Presentation transcript:

1 L ONG TERM OUTCOMES OF PATIENTS WITH LEIOMYOSARCOMA OF UTERINE VS. EXTRA - UTERINE ORIGIN Srikanth Divi, Medical Student, Univ. of Pittsburgh Meghan Levy, Kurt Weiss MD, Mark Goodman MD, Richard McGough MD

2 B ACKGROUND OF L EIOMYOSARCOMA (LMS) Approximately 10,000 soft tissue sarcomas are diagnosed in the US annually 1 LMS composes up to 10% (1000 cases) and is the third most frequent sarcoma after pleomorphic sarcoma NOS and liposarcoma 2 Classification: visceral gastrointestinal, separate from GIST uterine somatic peripheral soft tissues (cutaneous, deep soft tissue) retroperitoneal (50%) vascular bone (rare)

3 About 2/3 of retroperitoneal LMS occur in women, median age 60 y Presenting symptoms nonspecific: abdominal mass, swelling, pain, weight loss, nausea, or vomiting Presenting size often large (mean size and weight: 16 cm, 1600g) In contrast, tumors of the extremities affect men and women equally Significantly smaller (6 cm) than retroperitoneal tumors B ACKGROUND OF L EIOMYOSARCOMA (LMS)

4 Leiomyomas not necessarily associated with malignant transformation to LMS Observation that significant number of tumors arise from small blood vessels LMS also seen in the setting of hereditary retinoblastoma (abnormal Rb1 locus) B ACKGROUND OF L EIOMYOSARCOMA (LMS)

5 P ROGNOSIS OF PATIENTS WITH SOMATIC SOFT TISSUE (SST) LMS Farshid et al., 42 patients 3 (2002) 8% developed local recurrence, 45% developed mets Age > 62, size > 4cm, extensive necrosis correlated with metastasis Conclusion: majority are of vascular origin (39/42 pts), disruption of tumor w/ biopsy is significant RF Mankin et al., 66 patients 4 (2004) 50% survival at 4.2 years, 62% developed mets Tumors with greater size (>500 cm 3 ) had 82% mortality rate Conclusion: presence of mets, size of tumor, MSTS stage effect on survival outcomes

6 P ROGNOSIS OF PATIENTS WITH SOMATIC LMS Scandinavian Sarcoma Group, 225 pts (2006) 5 10 year survival rate (with localized disease): 49% Higher grade, larger tumor size, deeper location all significantly correlated with decreased survival Overall prognosis is poor even with local control (w/ or w/o radiotherapy) Abraham et al. 115 pts (2012) 1 1, 5, and 10 year survival: 87%, 57%, 19% Histological grade, tumor depth, and mets significant predictors of mortality

7 P ROGNOSIS OF PATIENTS WITH SOMATIC LMS Radkowski et al., 65 pts – Overall 1, 2, and 5 year survival: 91%, 87%, and 68% Pts with deep lesions, grade 3 disease, and advanced stage have poorer prognosis

8 U TERINE LMS Uterine LMS is rare, it accounts for only 1% of all uterine cancers 6, however it represents up to 1/3 of all uterine sarcomas 30-35% of patients have evidence of extra-uterine disease at the time of presentation 5 year survival for metastatic disease is less than 40% with current therapies Median age: 50 years, about 10 years older than the median age of presentation for leiomyoma 7 Frequency of incidental LMS detected in women at various ages having surgery for presumed leiomyoma: y: 0.2% y: 0.9% y: 1.4% y: 1.7%

9 M OTIVATION FOR STUDY Does extra-uterine LMS have the same prognosis as uterine LMS? Some patients with extra-uterine LMS had hysterectomies in the past Difference in outcomes between those with and those without hysterectomies? Two distinct disease entities (uterine LMS and extra-uterine LMS) may actually overlap, with patients presenting decades later with recurrences of uterine LMS.

10 H YPOTHESIS Patients with uterine LMS have decreased survival compared to extra-uterine LMS Of patients with extra-uterine LMS, those with prior hysterectomies have decreased survival

11 M ETHODS Searched using MARS (Medical Archive Record System) in UPMC system from 1982-present Surgical pathology reports with designated search terms Retrieved lists were filtered for correct diagnoses Diagnosis of extra-uterine LMS 513 cases of extra-uterine LMS Included tumors from: GI, cutaneous, peripheral soft tissue, retroperitoneal, vascular, etc. Diagnosis of uterine LMS 127 patients

12 M ETHODS Patient characteristics identified: age at diagnosis tumor characteristics (size, # mitoses, % necrosis, grade, FIGO stage) metastases Survival data collected from: UPMC patient charts (inpatient and outpatient visits) National and municipal registries Censored survival data used to construct Kaplan Meier curves

13 R ESULTS Uterine LMS Extra-uterine LMS Sample Size Median Survival yr 49.4%46.7% 10 yr 31.5%27.3% 15 yr 24.5%20.0% 25 yr 18.4%11.8% Hazard Ratio:1.042 [0.815, 1.333] Logrank Test: χ 2 = , p =

14 R ESULTS

15 R ESULTS – ANALYSIS OF PATIENTS WITH E XTRA - UTERINE LMS Of the 513 patients with extra-uterine LMS: 269 were females 177 with no documentation of hysterectomies 75 found to have hysterectomies prior to dx of LMS 17 had hysterectomies after dx of LMS 75/269 = 27.9% of females with hysterectomies prior to dx of LMS Differences in survival?

16 R ESULTS – ANALYSIS OF PATIENTS WITH E XTRA - UTERINE LMS Median Survival Time Median EstimateStd. Error 95% Confidence Interval Lower Bound Upper Bound No hyst Prior Hyst Overall Overall Comparisons Chi-SquaredfSig. Log Rank (Mantel-Cox)

17 D ISCUSSION Uterine vs. extra-uterine LMS has similar long term outcomes, not statistically significant Median survival: 4.97 y vs y HR 1.042, p = 0.74 Among extra-uterine LMS, those with prior hysterectomies had a longer survival time, not statistically significant Median: 6.42 y vs y p = 0.084

18 L IMITATIONS Population heterogeneity Does not stratify for commonly used clinical parameters: Margin status XRT Chemotherapy Other treatments

19 C ONCLUSION Retrospective review of 640 cases of LMS Uterine Extra-uterine No difference in long term survival outcomes Future directions: Evaluate contribution of clinical parameters Outcomes of patients with somatic soft tissue LMS

20 R EFERENCES Abraham et al. Outcomes and prognostic factors for a consecutive case series of 115 patients with somatic leiomyosarcoma. J Bone Joint Surg Am Apr 18; 94(8): OSullivan et al. Radiological imaging features of non-uterine leiomyosarcoma. Br J Radiol Jan; 81(961): Farshid et al. Leiomyosarcoma of Somatic Soft Tissues. Am J Surg Pathol (1): 14–24. Mankin et al. Leiomyosarcoma of Somatic Soft Tissues. Clin Orthop Relat Res Apr ; (421): Radkowski et al. Leiomyosarcoma of the somatic soft tissues. J Surg Orthop Adv (2): Leitao et al. Surgical cytoreduction in patients with metastatic uterine leiomyosarcoma at the time of initial diagnosis. Gynecol Oncol May. 125(2):

21 A CKNOWLEDGMENTS Meghan Levy Alma Heyl – Clinical Research Coordinator Kurt Weiss, MD and Mark Goodman, MD Richard McGough, MD – Project Mentor

22 T HANK YOU


Download ppt "L ONG TERM OUTCOMES OF PATIENTS WITH LEIOMYOSARCOMA OF UTERINE VS. EXTRA - UTERINE ORIGIN Srikanth Divi, Medical Student, Univ. of Pittsburgh Meghan Levy,"

Similar presentations


Ads by Google