The retrospective analysis of patients with uterine sarcomas: A single-center experience

Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma

Background: Recent studies have demonstrated that the tumor microenvironment, known to be influenced by inflammatory cells, plays a crucial role in cancer progression and clinical outcome of patients. The objective of the present study was to investigate prognostic values of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for disease-free survival (DFS) and overall survival (OS) of uterine sarcoma patients. Methods: Ninety-nine patients with uterine sarcoma treated in eight multicenter institutions over the last 20 years were retrospectively analyzed. Curves of DFS and OS were calculated using the Kaplan–Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model. Results: High NLR was significantly associated with worse DFS (p = 0.007) and OS (p = 0.039). Advanced stage (p = 0.017) and high mitotic index (p = 0.036) retained their prognostic significance for DFS. Other clinical variables, including PLR, CA125, and lactate dehydrogenase (LDH) failed to show significant impact. Conclusions: Our findings showed that an elevated preoperative NLR was associated with poor clinical outcome in uterine sarcoma patients. Our results suggest that high NLR in early-stage uterine sarcoma patients might indicate that such patients need more intensive treatments.

Outcomes of patients with pelvic leiomyosarcoma treated by surgery and relevant auxiliary diagnosis

BACKGROUND

Leiomyosarcoma is a subtype of soft tissue sarcoma with adverse outcomes. Leiomyosarcoma accounts for nearly 70% of all uterine sarcomas and is responsible for a considerable proportion of deaths because of uterine cancer. Clinical characteristics and relevant diagnosis of pelvic leiomyosarcoma should be further explored.

AIM

To identify the outcome and relevant perioperative evaluation of patients with pelvic leiomyosarcoma.

METHODS

The Kaplan-Meier method was used to determine progression-free survival and overall survival rates. Factors predictive of outcomes were identified using univariate and multivariate Cox proportional hazards models.

RESULTS

Fifty-one patients with pelvic leiomyosarcoma were enrolled and divided into two groups including uterine leiomyosarcoma and non-uterine leiomyosarcoma. Overall, 28.6% and 45.5% of uterine leiomyosarcoma and non-uterine leiomyosarcoma patients, respectively, had elevated carbohydrate antigen 125 levels, whereas 45.7% and 68.8%, respectively, underwent ultrasonography. Although 68.8% of uterine leiomyosarcoma patients were initially diagnosed with hysteromyoma, 72.7% of non-uterine leiomyosarcoma patients had pelvic and abdominal masses. Moreover, 93.3% of the recurrent lesions were detected using ultrasonography. Patients with International Federation of Gynaecology and Obstetrics (FIGO) stages III–IV disease had poorer progression-free survival values than those with FIGO stages I–II (P = 0.027) disease. FIGO stage was significantly associated with poor progression-free survival in the univariate (hazard ratio = 2.64, P = 0.03) and multivariate (hazard ratio = 2.49, P = 0.048) analyses.

CONCLUSION

Serum tumour biomarkers cannot be used for pelvic leiomyosarcoma diagnosis. FIGO stage is critical to predict the outcome of uterine leiomyosarcoma. Ultrasonography is more reliable for postoperative follow-up than preoperative diagnosis.

Outcome of adjuvant radiotherapy after total hysterectomy in patients with uterine leiomyosarcoma or carcinosarcoma: a SEER-based study

BACKGROUND

The clinical impact of adjuvant radiotherapy on uterine sarcoma is unclear, and may depend on the histological type. Hence, the aim of this study was to evaluate clinical outcomes of adjuvant radiotherapy after total hysterectomy in patients with leiomyosarcoma or carcinosarcoma.

METHODS

Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. Cox proportional hazards regression analyses were performed to identify risk factors for overall mortality and cancer-specific mortality. In addition, a 1:1 propensity score matching approach was performed, in which age group, disease stage, tumor grade, tumor size, and lymphadenectomy status were matched.

RESULTS

A total of 566 leiomyosarcoma and 1069 carcinosarcoma patients with stage I-III disease were included. Both regular Cox regression analysis and propensity score matching analysis revealed that utilization of adjuvant radiotherapy did not affect overall and cancer-specific mortality in patients with leiomyosarcoma. In contrast, for patients with carcinosarcoma, total mortality risk was significantly decreased with EBRT, brachytherapy, and combination radiotherapy compared with no radiotherapy. Cancer-specific mortality risk was significantly decreased with brachytherapy and combination radiotherapy as compared with no radiotherapy. Propensity score matching analyses revealed similar results in overall mortality, but not cancer-specific mortality, in patients with carcinosarcoma. Furthermore, the frequency of patients who did not receive any form of adjuvant radiotherapy was four times higher than those underwent adjuvant radiotherapy.

CONCLUSIONS

Adjuvant radiotherapy may provide a survival benefit for uterine carcinosarcoma, but not leiomyosarcoma. In addition, adjuvant radiotherapy is underutilized, and increased utilization of adjuvant radiotherapy may improve the survival rate of patients with carcinosarcoma.