Clinical Status And Prognostic Analysis Of Leiomyosarcoma Of Female Reproductive System

Objective : To analyze the clinical features of patients with Leiomyosarcoma(LMS)of the female reproductive system,and identify possible factors related with the prognosis.Methods:51 patients with LMSs of the female reproductive system treated in the First Affiliated Hospital of Chongqing Medical University from January 2009 to June 2020 were analyzed retrospectively.SPSS 25.0was used to analyze the data.P < 0.05 indicated statistical significance.Results : We enrolled 51 patients with LMSs of the female reproductive system,which included ULMSs(n=32)and extrauterine LMSs(n=19).The median age was 40 years old.There were 22 stage I patients,3 stage II patients,1 stage III patients,and 6 stage IV patients in the ULMS group.Extrauterine LMSs were not staged.Survival analysis was performed on 44 LMS patients.The median follow-up time was 39 months.The 3-year PFS and OS were 52.9% and71.6%,respectively.In univariate analysis,premenopausal patients had longer PFS(HR = 0.513,95% CI: 0.297-0.886;P <0.05)and OS(HR =0.529,95% CI: 0.308-0.908;P <0.05).Age,size,tumor location,BMI,history of fibroids,pathological type,tumor size,surgical route,ovarian preservation or not,performed or not performed lymphadenectomy,present or absent residual disease,present or absent adjuvant treatment after surgery,the degree of Ki-67 and expression of ER/PR or not had no statistical significance on the prognosis of patients.In the multivariate analysis,we didn’t find independent prognostic factors affecting PFS and OS in LMS patients.Survival analysis was performed on 27 ULMS patients.The median follow-up time was 45 months.The 3-year PFS and OS were 67.8% and 76.9%,respectively.In univariate analysis,younger(<47 years)patients had longer PFS(HR=0.213,95% CI: 0.045-1.012;P<0.05)and OS(HR = 0.232,95% CI: 0.049-1.097;P <0.05).Premenopausal patients had longer PFS(HR = 0.385,95% CI: 0.193-0.767;P <0.05)and OS(HR = 0.419,95% CI: 0.212-0.828;P <0.05).Patients in the early-stage had longer PFS(HR = 2.204,95% CI: 1.107-4.392;P <0.05)and OS(HR = 2.082,95% CI: 1.050-4.131;P <0.05).BMI,history of fibroids,pathological type,tumor size,surgical route,ovarian preservation or not,performed or not performed lymphadenectomy,present or absent residual disease,present or absent adjuvant treatment after surgery,the degree of Ki-67 and expression of ER/PR or not had no statistical significance on the prognosis of patients.Ovarian preservation and adjuvant treatment after surgery did not improve prognosis of patients with early FIGO stage.In multivariate analysis,FIGO stage was an independent prognostic factor.ULMS patients with advanced FIGO stage increased the risk of recurrence(HR = 19.343,95% CI: 1.918-195.071;P <0.05)and the risk of death(HR = 13.804,95% CI: 1.878-101.489;P <0.05).Conclusions : Ovarian preservation could be considered in premenopausal patients with early FIGO stage ULMS.Menopausal status was significantly related to the prognosis of LMS of female reproductive system.Independent prognosis factors affecting the prognosis in LMS of female reproductive system were not found.Age,menopausal status and FIGO stage were significantly related to the prognosis of ULMS.FIGO stage was an independent prognosis factor for survival in ULMS.