TY - JOUR
T1 - Clinical status and prognostic factors in Japanese patients with uterine leiomyosarcoma
AU - Takehara, Kazuhiro
AU - Yamashita, Natsumi
AU - Watanabe, Reiko
AU - Teramoto, Norihiro
AU - Tsuda, Hitoshi
AU - Motohashi, Takashi
AU - Harano, Kenichi
AU - Nakanishi, Toru
AU - Tokunaga, Hideki
AU - Susumu, Nobuyuki
AU - Ueda, Yutaka
AU - Yokoyama, Yoshihito
AU - Saito, Toshiaki
N1 - Funding Information:
We thank Shingi Fukunaga, MD, PhD, from Shin-Yurigaoka General Hospital, Tsunehisa Kaku, MD, PhD, from Fukuoka Sanno Hospital, and Masayuki Yoshida, MD, PhD, from the National Cancer Center Hospital Japan, as the member of CPR board. We also thank Susan Furness, PhD, and H. Nikki March, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. Dr. Takehara reports personal fees from AstraZeneca, Daiichi Sankyo, Chugai Pharmaceutical, and Eisai outside the submitted work. Dr. Tsuda reports grants from Taiho Pharmaceutical and Chugai Pharmaceutical during the conduct of the study. Dr. Saito reports grants and personal fees from Chugai Pharmaceutical, grants from Taiho Pharmaceutical, Yakult Honsha, Japan Agency for Medical Research and Development, and the National Hospital Organization, and grants and personal fees from Nippon Kayaku Pharmaceutical outside the submitted work. Conception and design: Kazuhiro Takehara, Takashi Motohashi, Kenichi Harano, Toru Nakanishi, Hideki Tokunaga, Nobuyuki Susumu, Yutaka Ueda, Yoshihito Yokoyama, Toshiaki Saito, Data analysis and interpretation: Kazuhiro Takehara, Natsumi Yamashita, Collection and assembly of histopathological data: Kazuhiro Takehara, Reiko Watanabe, Norihiro Teramoto, Hitoshi Tsuda, Manuscript writing: All authors, Final approval of manuscript: All authors, Accountable for all aspects of the work: All authors, This work was supported by the Japanese Gynecologic Oncology Group (JGOG), which was supported by unrestricted grants from AstraZeneca, Asuka Pharmaceutical, Bristol-Myers Squibb, Chiyoda Technology Corporation, Chugai Pharmaceutical, Daiichi-Sankyo, Eisai, Fuji Pharma, Janssen Pharmaceutical, Kaken Pharmaceutical, Kyowa Hakko Kirin, Nippon Kayaku, Ono Pharmaceutical, Roche-Diagnostics, Sanofi-Aventis, Sawai Pharmaceutical, Shionogi, SHISEIDO, Taiho Pharmaceutical, Yakult Honsha, and ZERIA Pharmaceutical.
Funding Information:
Dr. Takehara reports personal fees from AstraZeneca, Daiichi Sankyo, Chugai Pharmaceutical, and Eisai outside the submitted work. Dr. Tsuda reports grants from Taiho Pharmaceutical and Chugai Pharmaceutical during the conduct of the study. Dr. Saito reports grants and personal fees from Chugai Pharmaceutical, grants from Taiho Pharmaceutical, Yakult Honsha, Japan Agency for Medical Research and Development, and the National Hospital Organization, and grants and personal fees from Nippon Kayaku Pharmaceutical outside the submitted work.
Funding Information:
This work was supported by the Japanese Gynecologic Oncology Group (JGOG), which was supported by unrestricted grants from AstraZeneca, Asuka Pharmaceutical, Bristol-Myers Squibb, Chiyoda Technology Corporation, Chugai Pharmaceutical, Daiichi-Sankyo, Eisai, Fuji Pharma, Janssen Pharmaceutical, Kaken Pharmaceutical, Kyowa Hakko Kirin, Nippon Kayaku, Ono Pharmaceutical, Roche-Diagnostics, Sanofi-Aventis, Sawai Pharmaceutical, Shionogi, SHISEIDO, Taiho Pharmaceutical, Yakult Honsha, and ZERIA Pharmaceutical.
Publisher Copyright:
© 2020 The Authors
PY - 2020/4
Y1 - 2020/4
N2 - Objective: Uterine leiomyosarcoma (uLMS) is a rare gynecologic malignancy for which the currently available treatments do not consistently provide long-term disease control. This study aimed to reveal the current clinical status of uLMS to support future clinical trials. Methods: This study enrolled patients with uLMS treated at 53 Japanese institutions from 2000 to 2012. Central pathological review (CPR) was performed. All cases were confirmed by CPR, and epidemiological features, treatment, and prognosis were analyzed statistically. Results: A total of 307 patients were enrolled. A diagnosis of uLMS was confirmed in 266 patients (86.6%) of patients after CPR, of whom data for 259 were analyzed. Of these, 186 (71.8%) patients underwent complete gross resection as primary therapy. Ninety-eight patients received no additional adjuvant therapy, while docetaxel and gemcitabine was the most frequent regimen among 155 patients treated with adjuvant chemotherapy. In all cases, the median overall survival (OS) was 44.2 months. Multivariate analyses of prognostic factors in all cases identified stage III and IV disease, high serum lactate dehydrogenase level, and menopausal status as poor prognostic factors. However, in stage I cases, high serum lactate dehydrogenase level and no adjuvant treatment were identified as poor prognostic factors. The 5-year OS of patients with stage I uLMS treated with adjuvant chemotherapy was significantly better than that of those without adjuvant treatment (67.8% vs 46.7%, P = 0.0461). Conclusions: Despite complete removal of the primary lesion, the clinical course of patients with uLMS was poor due to recurrence of distant metastasis. The application of a suitable biomarker and effective adjuvant chemotherapy are required to improve the prognosis of patients with uLMS.
AB - Objective: Uterine leiomyosarcoma (uLMS) is a rare gynecologic malignancy for which the currently available treatments do not consistently provide long-term disease control. This study aimed to reveal the current clinical status of uLMS to support future clinical trials. Methods: This study enrolled patients with uLMS treated at 53 Japanese institutions from 2000 to 2012. Central pathological review (CPR) was performed. All cases were confirmed by CPR, and epidemiological features, treatment, and prognosis were analyzed statistically. Results: A total of 307 patients were enrolled. A diagnosis of uLMS was confirmed in 266 patients (86.6%) of patients after CPR, of whom data for 259 were analyzed. Of these, 186 (71.8%) patients underwent complete gross resection as primary therapy. Ninety-eight patients received no additional adjuvant therapy, while docetaxel and gemcitabine was the most frequent regimen among 155 patients treated with adjuvant chemotherapy. In all cases, the median overall survival (OS) was 44.2 months. Multivariate analyses of prognostic factors in all cases identified stage III and IV disease, high serum lactate dehydrogenase level, and menopausal status as poor prognostic factors. However, in stage I cases, high serum lactate dehydrogenase level and no adjuvant treatment were identified as poor prognostic factors. The 5-year OS of patients with stage I uLMS treated with adjuvant chemotherapy was significantly better than that of those without adjuvant treatment (67.8% vs 46.7%, P = 0.0461). Conclusions: Despite complete removal of the primary lesion, the clinical course of patients with uLMS was poor due to recurrence of distant metastasis. The application of a suitable biomarker and effective adjuvant chemotherapy are required to improve the prognosis of patients with uLMS.
KW - Chemotherapy
KW - Clinical feature
KW - Leiomyosarcoma
KW - Prognostic factor
KW - Uterus
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U2 - 10.1016/j.ygyno.2020.01.022
DO - 10.1016/j.ygyno.2020.01.022
M3 - Article
C2 - 31983515
AN - SCOPUS:85078154426
VL - 157
SP - 115
EP - 120
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 1
ER -