Prognostic factors and impact of adjuvant chemotherapy for uterine leiomyosarcoma

OBJECTIVE: The aim of this study was to investigate prognostic factors and impact of adjuvant therapy for uterine leiomyosarcoma (LMS). METHODS: All cases with uterine LMS were retrieved from medical registry (1984 through 2003) of Chang Gung Memorial Hospital. After excluding cases with initial surgery at outside the hospital, missing chart, and wrong pathologic diagnosis, 51 patients (41 for stage I, 7 for stage III, and 3 for stage IV) met the study criteria. Approximate stratified analysis and Cox proportional hazards model were used to adjust confounding factors. RESULTS: The median follow-up for survivors was 47 months. Five-year overall survival and recurrence-free survival (RFS) rates were 67.4% and 59.2% for the whole series. Multivariate Cox regression analyses selected age (>50 versus < or =50 years: relative risk RR], 11.07 95% CI 1.53-80.34]), tumor size (>11 versus < or =11 cm: RR, 11.63 95% CI 2.14-63.12]), stage (III and IV versus I: RR, 21.24 95% CI 2.20-204.98]), and adjuvant chemotherapy (yes versus no: RR, 0.08 95% CI 0.01-0.81]) as significant predictors of death. Besides, surgical stage (P = 0.021), tumor size (P = 0.005), and adjuvant chemotherapy (P = 0.011) were significantly correlated with RFS. After approximate stratification, the use of adjuvant chemotherapy also significantly decreased RR of death. CONCLUSIONS: This is the first report to demonstrate benefit of adjuvant chemotherapy for LMS despite the limitation of sample size and its retrospective nature. Prospective multicenter trials are necessary to clarify the role of chemotherapy, selecting criteria, and optimal chemotherapy regimen for uterine LMS.