The impact of tumor fragmentation in patients with stage I uterine leiomyosarcoma on patterns of recurrence and oncologic outcome Journal Article


Authors: Pedra Nobre, S.; Hensley, M. L.; So, M.; Zhou, Q. C.; Iasonos, A.; Leitao, M. M. Jr; Ducie, J.; Chiang, S.; Mueller, J. J.; Abu-Rustum, N. R.; Zivanovic, O.
Article Title: The impact of tumor fragmentation in patients with stage I uterine leiomyosarcoma on patterns of recurrence and oncologic outcome
Abstract: Objective: To evaluate the impact of tumor fragmentation on oncologic outcomes in patients with stage I uterine leiomyosarcoma (uLMS). Methods: We identified all patients diagnosed with stage I uLMS presenting to our institution within three months of primary surgery, 1/2000–1/2019. Patients with recurrent disease were excluded. The non-morcellated group had total hysterectomy without documented specimen fragmentation; the morcellated group, total hysterectomy with documented specimen fragmentation. We defined fragmentation as manual fragmentation or morcellation (via power morcellator or otherwise) of the specimen in peritoneal cavity or vagina. Appropriate statistical analyses were performed. Results: 152 patients met inclusion criteria. 107 (70%) underwent total hysterectomy (non-morcellated); 45 (30%) underwent morcellation. Median age at diagnosis for the entire cohort was 55 years (range 30–91). Median follow-up was 42.1 months (range 1.1–197.8). 40 (26.3%) patients had primary surgery at our institution, 112 (73.7%) at an outside hospital. In total 110 (72.3%) recurred: 72/107 (67.2%) non-morcellated; 38/44 (86.3%) morcellated. Median progression-free survival (PFS) for non-morcellated versus morcellated was 13.8 (95%CI 9.2–20.2) versus 7.3 months (95%CI 3–13.1), HR 1.5 (95%CI 1.02–2.24); P = 0.04. Median overall survival (OS) for non-morcellated versus morcellated was 82.1 (95%CI 52.4–122) versus 47.8 months (95%CI 28.5–129.6), HR 1.1 (95%CI 0.67–1.82); P = 0.7. Among patients with recurrence, 69.4% of non-morcellated recurred at hematogenous sites only, 18.1% recurred in peritoneum only; 28.9% of morcellated recurred at hematogenous sites, 63.2% in peritoneum. Race, lymphovascular invasion, postoperative chemotherapy, were independently associated with PFS. Mitotic index was independently associated with OS. Conclusions: Tumor fragmentation/morcellation was associated with significantly higher risk of recurrence and a nearly 4-fold increase in peritoneal recurrence. Prognostic biomarkers remain important in predicting oncologic outcomes, independent of fragmentation or treatment. © 2020 Elsevier Inc.
Keywords: adult; cancer chemotherapy; aged; major clinical study; overall survival; cancer recurrence; cancer radiotherapy; postoperative care; follow up; antineoplastic agent; hysterectomy; salpingooophorectomy; progression free survival; cohort analysis; recurrence; cancer hormone therapy; cancer size; minimally invasive surgery; leiomyosarcoma; race difference; uterine leiomyosarcoma; uterus sarcoma; myomectomy; mitosis index; peritoneum; clinical outcome; peritoneal cavity; cervicectomy; morcellation; open surgery; lymph vessel metastasis; human; female; priority journal; article
Journal Title: Gynecologic Oncology
Volume: 160
Issue: 1
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2021-01-01
Start Page: 99
End Page: 105
Language: English
DOI: 10.1016/j.ygyno.2020.10.020
PUBMED: 33158511
PROVIDER: scopus
PMCID: PMC7779751
DOI/URL:
Notes: Article -- Export Date: 1 February 2021 -- Source: Scopus
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MSK Authors
  1. Mario Leitao
    442 Leitao
  2. Oliver Zivanovic
    212 Zivanovic
  3. Qin Zhou
    171 Zhou
  4. Alexia Elia Iasonos
    258 Iasonos
  5. Martee L Hensley
    257 Hensley
  6. Jennifer Jean Mueller
    99 Mueller
  7. Sarah   Chiang
    99 Chiang