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

Predictive value of FIGO and AJCC staging systems in patients with uterine leiomyosarcoma

BACKGROUND

Cancer staging systems aim to identify patient cohorts with different outcomes based on clinically relevant prognostic factors. Uterine leiomyosarcoma (ULMS) is classified using the FIGO staging system developed for epithelial malignancies; other sarcomas use the AJCC staging system. Neither has been validated in ULMS. We critically evaluated both systems to determine if either identified patient groups with distinct outcomes.

METHODS

We staged 230 ULMS patients by the FIGO and AJCC systems. Progression-free survival (PFS) and overall survival (OS) rates were calculated; statistical pairwise comparisons were performed.

RESULTS

The number of stages I and III patients varied by staging system. There were few stage II patients by either system. Using the FIGO system, PFS was better in stage I patients versus stage III or IV patients, and OS was better in stage I patients versus stage IV patients. Using the AJCC system, PFS and OS were better in stage I patients (low grade) versus stage II, III or IV patients, and OS was better in stage III patients versus stage IV patients. Prognosis of patients with serosal involvement (FIGO III) was similar to that of patients with metastases (FIGO IV).

CONCLUSION

Neither system classifies ULMS patients into four clinically meaningful, non-overlapping stages predictive of PFS and OS. This analysis highlights the relevance of certain factors (low grade, serosal involvement) and rarity of others (FIGO stage II, cervical invasion). Once identified, prognostic factors relevant to this malignancy should be incorporated into a new staging system in an effort to identify appropriate cohorts for different treatments.

[Uterine sarcoma treatment]

There are many common features between uterine sarcomas - leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma and adenosarcoma -with regards to course, therapy and follow-up, such as post-menopausal bleeding or additional premenopausal bleeding, as well as rapid growth. There is a new staging system according to FIGO and new therapy recommendations according to NCCN. Prior to therapy, imaging staging of the pelvis, abdomen and chest should be carried out due to the frequency with which metastases are found at the time of diagnosis. In the case of disease spread in uterine sarcomas and malignant mixed tumors, good supportive therapy is a possible therapy option instead of chemo- or radiotherapy. The approach - observation, surgery, lymphonodectomy, mono- or polychemotherapy, radiotherapy, hormone therapy - is chosen according to the extent of spread and the resection status. Neoadjuvant therapies are not as yet established.