Stage-specific outcomes of patients with uterine leiomyosarcoma: A comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer staging systems Journal Article


Authors: Hensley, M. L.; Zivanovic, O.; Leitao, M. M.; Iasonos, A.; Jacks, L. M.; Zhou, Q.; Abu-Rustum, N. R.; Soslow, R. A.; Juretzka, M. M.; Chi, D. S.; Barakat, R. R.; Brennan, M. F.
Article Title: Stage-specific outcomes of patients with uterine leiomyosarcoma: A comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer staging systems
Abstract: Purpose Uterine leiomyosarcoma (LMS) is staged by the modified International Federation of Gynecology and Obstetrics (FIGO) staging system for uterine cancer. We aimed to determine whether the American Joint Committee on Cancer (AJCC) soft tissue sarcoma (STS) staging system is more accurate in predicting progression-free survival (PFS) and overall survival (OS). Patients and Methods Patients with uterine LMS who presented at our institution from 1982 to 2005 were staged retrospectively according to a modified FIGO staging system and the AJCC STS staging system. The predictive accuracy of the two staging systems was compared using concordance estimation. Results Two hundred nineteen patients had sufficient clinical and pathologic information to be staged under both systems; 132 patients were upstaged using the AJCC staging system, whereas only four were downstaged. Stage-specific PFS and OS rates for stages I, II, and III differed substantially between the two staging systems. In both systems, there was prognostic overlap between stages II and III. Thus, despite the marked stage-specific differences in 5-year PFS and OS rates for stages I, II, and III, both systems had similar concordance indices. Conclusion Estimates of stage-specific PFS and OS for uterine LMS were altered substantially when using the AJCC versus FIGO staging system. Adjuvant treatment strategies should be tested in patients at substantial risk for disease progression and death. Neither the FIGO nor AJCC staging system is ideal for identifying such patients, suggesting a need for a uterine LMS-specific staging system to better target patients for trials of adjuvant therapies. © 2009 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; survival rate; major clinical study; overall survival; comparative study; cancer staging; lymphatic metastasis; neoplasm staging; accuracy; progression free survival; risk factors; retrospective study; prediction; survival time; leiomyosarcoma; uterus cancer; health care organization; gynecology; uterine cervical neoplasms; obstetrics; uterus sarcoma; international agencies
Journal Title: Journal of Clinical Oncology
Volume: 27
Issue: 12
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2009-04-20
Start Page: 2066
End Page: 2072
Language: English
DOI: 10.1200/jco.2008.19.8366
PUBMED: 19255317
PROVIDER: scopus
PMCID: PMC3646302
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 30 November 2010" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Murray F Brennan
    748 Brennan
  2. Richard R Barakat
    579 Barakat
  3. Dennis S Chi
    492 Chi
  4. Mario Leitao
    304 Leitao
  5. Oliver Zivanovic
    114 Zivanovic
  6. Qin Zhou
    117 Zhou
  7. Alexia Elia Iasonos
    169 Iasonos
  8. Martee L Hensley
    211 Hensley
  9. Robert Soslow
    636 Soslow
  10. Lindsay Jacks
    37 Jacks