Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Management of uterine sarcomas and prognostic indicators: real world data from a single-institution

Authors: Anastasios Kyriazoglou, Michael Liontos, Dimitrios C Ziogas, Flora Zagouri, Kostantinos Koutsoukos, Giorgos Tsironis, Anna Tsiara, Maria Kaparelou, Roubini Zakopoulou, Nikolaos Thomakos, Dimitrios Haidopoulos, Irene Papaspyrou, Alexandros Rodolakis, Aristotelis Bamias, Meletios Athanasios Dimopoulos

Published in: BMC Cancer | Issue 1/2018

Login to get access

Abstract

Background

Uterine sarcomas consist a heterogeneous group of mesenchymal gynecological malignancies with unclear therapeutic recommendations and unspecific but poor prognosis, since they usually metastasize and tend to recur very often, even in early stages.

Methods

We retrospectively analyzed all female patients with uterine sarcomas treated in our institution over the last 17 years. Clinico-pathological data, treatments and outcomes were recorded. Kaplan-Meier curves were plotted and time-to-event analyses were estimated using Cox regression.

Results

Data were retrieved from 61 women with a median age of 53 (range: 27–78) years, at diagnosis. Fifty-one patients were diagnosed with leiomyosarcoma (LMS), 3 with high grade endometrial stromal sarcoma (ESS), 5 with undifferentiated uterine sarcoma (UUS), 1 with Ewing sarcoma (ES) and 1 with Rhabdomyosarcoma (RS). 24 cases had stage I, 7 stage II, 14 stage III and 16 stage IV disease. Median disease-free survival (DFS) in adjuvant approach was 18.83 months, and median overall survival (OS) 31.07 months. High mitotic count (> 15 mitoses) was significantly associated with worse OS (P < 0.001) and worse DFS (P = 0.028).

Conclusions

Mitotic count appears to be independent prognostic factor while further insights are needed to improve adjuvant and palliative treatment of uterine sarcomas.
Literature
1.
Bocker W. WHO classification of breast tumors and tumors of the female genital organs: pathology and genetics. Verh Dtsch Ges Pathol. 2002;86:116–9.PubMed
2.
Fletcher CD. The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification. Histopathology. 2014;64(1):2–11.CrossRef
3.
Bodner K, Bodner-Adler B, Obermair A, Windbichler G, Petru E, Mayerhofer S, Czerwenka K, Leodolter S, Kainz C, Mayerhofer K. Prognostic parameters in endometrial stromal sarcoma: a clinicopathologic study in 31 patients. Gynecol Oncol. 2001;81(2):160–5.CrossRef
4.
Feng W, Malpica A, Robboy SJ, Gudlaugsson E, Hua K, Zhou X, Baak JP. Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family. Int J Gynecol Pathol. 2013;32(3):299–306.CrossRef
5.
Lusby K, Savannah KB, Demicco EG, Zhang Y, Ghadimi MP, Young ED, Colombo C, Lam R, Dogan TE, Hornick JL, et al. Uterine leiomyosarcoma management, outcome, and associated molecular biomarkers: a single institution's experience. Ann Surg Oncol. 2013;20(7):2364–72.CrossRef
6.
Coindre JM, Terrier P, Bui NB, Bonichon F, Collin F, Le Doussal V, Mandard AM, Vilain MO, Jacquemier J, Duplay H, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14(3):869–77.CrossRef
7.
Pautier P, Genestie C, Rey A, Morice P, Roche B, Lhomme C, Haie-Meder C, Duvillard P. Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma. Cancer. 2000;88(6):1425–31.CrossRef
8.
Hanley KZ, Birdsong GG, Mosunjac MB. Recent developments in surgical pathology of the uterine corpus. Arch Pathol Lab Med. 2017;141(4):528–41.CrossRef
9.
Sandberg AA. Cytogenetics and molecular genetics of bone and soft-tissue tumors. Am J Med Genet. 2002;115(3):189–93.CrossRef
10.
Cui RR, Wright JD, Hou JY. Uterine leiomyosarcoma: a review of recent advances in molecular biology, clinical management and outcome. BJOG. 2017;124(7):1028–37.CrossRef
11.
Lee CH, Ou WB, Marino-Enriquez A, Zhu M, Mayeda M, Wang Y, Guo X, Brunner AL, Amant F, French CA, et al. 14-3-3 fusion oncogenes in high-grade endometrial stromal sarcoma. Proc Natl Acad Sci U S A. 2012;109(3):929–34.CrossRef
12.
Lewis N, Soslow RA, Delair DF, Park KJ, Murali R, Hollmann TJ, Davidson B, Micci F, Panagopoulos I, Hoang LN, et al. ZC3H7B-BCOR high-grade endometrial stromal sarcomas: a report of 17 cases of a newly defined entity. Mod Pathol. 2017.
13.
Micci F, Gorunova L, Agostini A, Johannessen LE, Brunetti M, Davidson B, Heim S, Panagopoulos I. Cytogenetic and molecular profile of endometrial stromal sarcoma. Genes Chromosomes Cancer. 2016;55(11):834–46.CrossRef
14.
Ratan R, Patel SR. Chemotherapy for soft tissue sarcoma. Cancer. 2016;122(19):2952–60.CrossRef
15.
Group ESESNW. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii102–12.CrossRef
16.
Mancari R, Signorelli M, Gadducci A, Carinelli S, De Ponti E, Sesana S, Corso S, Chiappa V, Colombo N, Lissoni AA. Adjuvant chemotherapy in stage I-II uterine leiomyosarcoma: a multicentric retrospective study of 140 patients. Gynecol Oncol. 2014;133(3):531–6.CrossRef
17.
Bogani G, Fuca G, Maltese G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Scaffa C, Sabatucci I, Lecce F, et al. Efficacy of adjuvant chemotherapy in early stage uterine leiomyosarcoma: a systematic review and meta-analysis. Gynecol Oncol. 2016;143(2):443–7.CrossRef
18.
Ducie JA, Leitao MM, Jr.: The role of adjuvant therapy in uterine leiomyosarcoma. Expert Rev Anticancer Ther 2016, 16(1):45–55.
19.
Gronchi A, Stacchiotti S, Verderio P, Ferrari S, Martin Broto J, Lopez-Pousa A, Llombart-Bosch A, Dei Tos AP, Collini P, Jurado JC, et al. Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian sarcoma group and the Spanish sarcoma group. Ann Oncol. 2016;27(12):2283–8.CrossRef
20.
Roque DR, Taylor KN, Palisoul M, Wysham WZ, Milam B, Robison K, Gehrig PA, Raker C, Kim KH. Gemcitabine and docetaxel compared with observation, radiation, or other chemotherapy regimens as adjuvant treatment for stage I-to-IV uterine Leiomyosarcoma. Int J Gynecol Cancer. 2016;26(3):505–11.CrossRef
21.
Seddon B, Strauss SJ, Whelan J, Leahy M, Woll PJ, Cowie F, Rothermundt C, Wood Z, Benson C, Ali N, et al. Gemcitabine and docetaxel versus doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft-tissue sarcomas (GeDDiS): a randomised controlled phase 3 trial. Lancet Oncol. 2017;18(10):1397–410.CrossRef
22.
Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Cho KR, Chu C, Cohn D, Crispens MA, Dizon DS, et al. Uterine sarcoma, version 1.2016: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2015;13(11):1321–31.CrossRef
23.
Schoffski P, Chawla S, Maki RG, Italiano A, Gelderblom H, Choy E, Grignani G, Camargo V, Bauer S, Rha SY, et al. Eribulin versus dacarbazine in previously treated patients with advanced liposarcoma or leiomyosarcoma: a randomised, open-label, multicentre, phase 3 trial. Lancet. 2016;387(10028):1629–37.CrossRef
24.
Benson C, Ray-Coquard I, Sleijfer S, Litiere S, Blay JY, Le Cesne A, Papai Z, Judson I, Schoffski P, Chawla S, et al. Outcome of uterine sarcoma patients treated with pazopanib: a retrospective analysis based on two European Organisation for Research and Treatment of Cancer (EORTC) soft tissue and bone sarcoma group (STBSG) clinical trials 62043 and 62072. Gynecol Oncol. 2016;142(1):89–94.CrossRef
25.
Angarita FA, Cannell AJ, Abdul Razak AR, Dickson BC, Blackstein ME. Trabectedin for inoperable or recurrent soft tissue sarcoma in adult patients: a retrospective cohort study. BMC Cancer. 2016;16:30.CrossRef
26.
Littell RD, Tucker LY, Raine-Bennett T, Palen TE, Zaritsky E, Neugebauer R, Embry-Schubert J, Lentz SE. Adjuvant gemcitabine-docetaxel chemotherapy for stage I uterine leiomyosarcoma: trends and survival outcomes. Gynecol Oncol. 2017;147(1):11–7.CrossRef
27.
Benson C, Miah AB. Uterine sarcoma - current perspectives. Int J Womens Health. 2017;9:597–606.CrossRef
28.
Gremel G, Liew M, Hamzei F, Hardell E, Selling J, Ghaderi M, Stemme S, Ponten F, Carlson JW. A prognosis based classification of undifferentiated uterine sarcomas: identification of mitotic index, hormone receptors and YWHAE-FAM22 translocation status as predictors of survival. Int J Cancer. 2015;136(7):1608–18.CrossRef
29.
Bacalbasa N, Balescu I, Dima S, Brasoveanu V, Popescu I. Prognostic factors and survival in patients treated surgically for primary and recurrent uterine leiomyosarcoma: a single center experience. Anticancer Res. 2015;35(4):2229–34.PubMed
30.
Hardell E, Josefson S, Ghaderi M, Skeie-Jensen T, Westbom-Fremer S, Cheek EH, Bell D, Selling J, Schoolmeester JK, Masback A, et al. Validation of a mitotic index cutoff as a prognostic marker in undifferentiated uterine sarcomas. Am J Surg Pathol. 2017;41(9):1231–7.CrossRef
31.
Andreou D, Werner M, Pink D, Traub F, Schuler M, Gosheger G, Jobke B, Reichardt P, Tunn PU. Prognostic relevance of the mitotic count and the amount of viable tumour after neoadjuvant chemotherapy for primary, localised, high-grade soft tissue sarcoma. Br J Cancer. 2015;112(3):455–60.CrossRef
32.
Lee C-H, Mariño-Enriquez A, Ou W, Zhu M, Ali RH, Chiang S, Amant F, Gilks CB, van de Rijn M, Oliva E, et al. The Clinicopathologic features of YWHAE-FAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol. 2012;36(5):641–53.CrossRef
33.
Ravid Y, Formanski M, Smith Y, Reich R, Davidson B. Uterine leiomyosarcoma and endometrial stromal sarcoma have unique miRNA signatures. Gynecol Oncol. 2016;140(3):512–7.CrossRef
34.
Davidson B, Micci F. Molecular characteristics of uterine sarcomas. Expert Rev Mol Diagn. 2017;17(5):515–22.CrossRef
35.
Lee CH, Ali RH, Rouzbahman M, Marino-Enriquez A, Zhu M, Guo X, Brunner AL, Chiang S, Leung S, Nelnyk N, et al. Cyclin D1 as a diagnostic immunomarker for endometrial stromal sarcoma with YWHAE-FAM22 rearrangement. Am J Surg Pathol. 2012;36(10):1562–70.CrossRef
36.
Feng W, Malpica A, Skaland I, Gudlaugsson E, Robboy SJ, Dalen I, Hua K, Zhou X, Baak JP. Can proliferation biomarkers reliably predict recurrence in World Health Organization 2003 defined endometrial stromal sarcoma, low grade? PLoS One. 2013;8(10):e75899.CrossRef
Metadata
Title
Management of uterine sarcomas and prognostic indicators: real world data from a single-institution
Authors
Anastasios Kyriazoglou
Michael Liontos
Dimitrios C Ziogas
Flora Zagouri
Kostantinos Koutsoukos
Giorgos Tsironis
Anna Tsiara
Maria Kaparelou
Roubini Zakopoulou
Nikolaos Thomakos
Dimitrios Haidopoulos
Irene Papaspyrou
Alexandros Rodolakis
Aristotelis Bamias
Meletios Athanasios Dimopoulos
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-5156-1

Other articles of this Issue 1/2018

BMC Cancer 1/2018 Go to the issue

Research article

Neuroendocrine carcinoma of the cervix: a systematic review of the literature

Research article

IFI44L is a novel tumor suppressor in human hepatocellular carcinoma affecting cancer stemness, metastasis, and drug resistance via regulating met/Src signaling pathway

Research article

Cost-effectiveness of prostate cancer screening: a systematic review of decision-analytical models

Research article

Improved effects of honokiol on temozolomide-induced autophagy and apoptosis of drug-sensitive and -tolerant glioma cells

Research article

Lesions of “uncertain malignant potential” in the breast (B3) identified with mammography screening

Research article

Phase II trial of eribulin mesylate as a first- or second-line treatment for locally advanced or metastatic breast cancer: a multicenter, single-arm trial
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits