IMR Press / EJGO / Volume 41 / Issue 3 / DOI: 10.31083/j.ejgo.2020.03.5107
Open Access Original Research
Ovarian conservation without postoperative radiation improved survival outcomes in patients with stage i uterine leiomyosarcoma
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1 Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
2 Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100006, China
Eur. J. Gynaecol. Oncol. 2020 , 41(3), 422–431; https://doi.org/10.31083/j.ejgo.2020.03.5107
Submitted: 15 November 2019 | Accepted: 5 June 2019 | Published: 15 June 2020
Abstract

Introduction: Little observational data exists regarding the efficacy of different treatment modalities on the survival outcome of patients with uterine leiomyosarcoma. Objective and Design: This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results database to identify surgery-based treated patients with uterine leiomyosarcoma diagnosed between 1982 to 2015 (N = 4289). The associations between survival outcomes and treatment modalities regarding postoperative radiation and ovarian conservation were assessed. Results: A total of 1104 patients were included in the study, 19.02% (210/1104) patients received postoperative radiation, 11.59% (128/110) patients received ovarian conservation. The median follow-up duration was 37.27 ± 34.69 months (95%CI: 35.39-39.38 months). After propensity score matching, there were no variable differences among compared groups. For FIGO stage I-II patients, postoperative radiation did not improve five-year-overall survival (49.1 vs. 47.1%, p = 0.818) and five-year-cause-specific survival (51.5 vs. 49.9%, p = 0.910). For International Federation of Gynecology and Obstetrics stage I patients who were younger than 50 years old, five-year-overall survival (75.4 vs. 60.3%, p = 0.053) and five-year-cause-specific survival (75.4 vs. 65.1%, p = 0.146) were similar between women underwent ovarian conservation and those who did not. However, after excluding patients who received radiotherapy, patients showed a better survival outcome than control group (five-year-overall survival: 76.3 vs. 54.0%, p = 0.031; five-year-cause-specific survival: 76.30 vs. 55.3%, p = 0.046). Conclusions: In women with stage I-II uterine leiomyosarcoma, postoperative radiation did not improve five-year-overall-survival and five-year-cause-specific survival. In young women with stage I uterine leiomyosarcoma who didn’t receive postoperative radiotherapy, ovarian conservation was associated with increased overall survival and cause-specific survival.

Keywords
Uterine leiomyosarcoma
Ovarian conservation
Postoperative radiation
Propensity score matching
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