title: Is vascular and lymphatic space invasion a main prognostic factor in uterine neoplasms with a sarcomatous component? A retrospective study of prognostic factors of 60 patients stratified by stages.
abstract: BACKGROUND
  Sarcomatous neoplasms of the uterine corpus are still a challenge in terms of obtaining prognostic factors and the most optimum complementary treatment to surgery. The most important prognostic factor is stage; relapses usually appear during the first 2 years, and most patients die within the first 3 years. We have performed a multivariate study of prognostic factors, stratifying patients by stage, to determine their impact on overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival. Special emphasis has been given to vascular and lymphatic space invasion (VLSI).
  
  
  METHODS
  Sixty patients diagnosed with uterine neoplasms with a main sarcomatous component were treated at Hospital Clínic i Universitari of Barcelona between January 1975 and June 1999. Pathologic type: 32 carcinosarcomas, 14 leiomyosarcomas, 9 adenosarcomas, and 5 endometrial stromal sarcomas.
  
  
  METHODS
  58/60 surgery, 35/60 postoperative radiotherapy, 2/60 exclusive chemotherapy, and 3/60 complementary chemotherapy. FIGO stages: 43 Stage I, 4 Stage II, 11 Stage III, and 2 Stage IV. Variables analyzed: age, stage, vascular and lymphatic space invasion, myometrial invasion, mitotic index, tumor size, unicentricity/multicentricity, necrosis, and radiotherapy.
  
  
  METHODS
  the S and Cox proportional risk models. The partial effect of each risk factor was calculated by hazard ratio (HR) with a confidence interval of 95%.
  
  
  RESULTS
  Early stages: Multivariate analysis showed that tumor size larger than 8 cm and VLSI had an impact on overall survival (HR = 4.01 and HR = 24.45, respectively). VLSI was present in 23% of the cases. Myometrial invasion greater than 50% had an impact on disease-free survival and local relapse-free survival (HR was 9.75 and 3.20, respectively). VLSI had an impact on distant metastasis-free survival (HR = 2.92). Advanced stages: VLSI was present in 89% of the cases. Only leiomyosarcoma type made the overall survival worse (HR = 10.54).
  
  
  CONCLUSIONS
  Vascular and lymphatic space invasion was a relevant prognostic factor in our series, with an impact on overall survival and distant metastasis-free survival in early stages. In advanced stages, VLSI had no impact on survival, but was present in 89% of cases. Myometrial invasion >50% had an impact on local relapse. Advanced stages had a more aggressive behavior, and there was a higher incidence of poor prognostic factors in these stages. Nevertheless, prospective studies are still needed on prognostic factors and on the best treatment option.
authors.affiliation: Department of Radiation Oncology, Hospital Clínic i Universitari, Barcelona, Spain. aroviro@medicina.ub.es
authors.forename: Angeles
authors.initials: A
authors.lastname: Rovirosa
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
authors.forename: Rosa
authors.initials: R
authors.lastname: Abellana
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
authors.forename: José-Antonio
authors.initials: JA
authors.lastname: Lejarcegui
authors.forename: Jaume
authors.initials: J
authors.lastname: Pahisa
authors.forename: Luis M
authors.initials: LM
authors.lastname: Puig-Tintoré
authors.forename: Begoña
authors.initials: B
authors.lastname: Mellado
authors.forename: Beatríz
authors.initials: B
authors.lastname: Armenteros
authors.forename: Xavier
authors.initials: X
authors.lastname: Iglesias
authors.forename: Albert
authors.initials: A
authors.lastname: Biete
mesh_terms: D018195:Adenosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology* / Q000556:secondary; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology*