Real-world outcomes and prognostic factors in uterine leiomyosarcom: A single center experience from India.

Abstract

e17620 Background: Uterine leiomyosarcoma (uLMS) is a rare and aggressive malignancy with dismal prognosis, often diagnosed incidentally after surgery for presumed benign disorders. There is a dearth of prospective data particularly in Indian women owing to its rarity. Published studies differ about prognostic factors, and the role of adjuvant treatment in uLMS. Methods: Prospectively maintained uterine cancer electronic database was used to include uLMS patients with adequate clinical information who underwent treatment between January 1, 2012 and December 31, 2021. Progression-free survival (PFS) and overall survival (OS) were calculated for the entire population, while recurrence-free survival (RFS) was calculated for the patients who had curative intent treatment. Various potential prognostic factors were tested using univariate and multivariate analysis. Results: Among 44 identified patients of uLMS, 32 women with sufficient information were included in the study. Majority of the patients had early stage disease at diagnosis including 19 (59.4%) patients with FIGO stage I tumors. Twenty three (71.9%) patients were diagnosed incidentally after surgery. Curative intent treatment was offered to 26 patients (81.3%) while 6 (18.7%) patients had palliative treatment. Median tumor size was 9 cm (interquartile range [IQR] 7-15), and the median mitotic count was 16 per 10 high power fields (hpf) (IQR, 12-25). Eleven patients (34.3%) received adjuvant chemotherapy while 15 patients (46.9%) remained on surveillance. After a median follow-up of 63.8 months, 22 patients (68.8%) had disease recurrence and 23 (71.9%) patients had died. Lung was the most common site (64.3%) of recurrence, followed by bone (18.8%), and abdominal cavity (12.5%). The median PFS and OS for the whole population were 20.7 months (95% confidence interval [CI] 13.7 - 27.7) and 28 months (95% CI 19.7 - 36.3) respectively. The 5-year PFS estimate was 20% while the 5-year survival probability was 25%. Stage specific 5-year OS probabilities for stage I, II, III, and IV were 45%, 40%, 20%, and 8% respectively. Patients who received adjuvant chemotherapy had longer RFS than those who were observed after primary surgery (median 59·9 months [95% CI 19.5–100.3] vs 20.5 months [95% CI 15.8-25.3]; hazard ratio [HR] 0·13 [95% CI 0.02-0.85; p = 0·03). Lower stage (FIGO stage I-II) (HR 0.15 [95% CI 0.03-0.67]; p = 0.013), and lower mitotic count (< 15/10 hpf) (HR 0.13 [95% CI 0.03-0.61]; p = 0.01) were independent prognostic factors associated with better survival. Conclusions: This 10-year experience of uLMS from an Indian tertiary care cancer center shows poor survival across stages with a high rate of recurrence. Only stage and mitotic count were found to be independent prognostic factors. The finding of RFS benefit with adjuvant chemotherapy warrants larger prospective studies to evaluate the role of adjuvant therapy in uLMS.