title: The influence of primary site on outcomes in leiomyosarcoma: a review of clinicopathologic differences between uterine and extrauterine disease.
abstract: BACKGROUND
  Leiomyosarcomas (LMS) comprise 25% of soft tissue sarcomas. Recent reports suggest differences in treatment outcomes between uterine (uLMS) and extrauterine (eLMS) disease that may reflect distinct disease biologies. We sought to identify prognostic factors in LMS and clinicopathologic differences between uLMS and eLMS.
  
  
  METHODS
  This is a single-center retrospective study evaluating 97 eligible patients treated for LMS between 2002 and 2010.
  
  
  RESULTS
  Median follow-up was 21.2 months. uLMS affected 53% of patients, and was less common beyond age 60 years compared with eLMS (10% vs. 37%, P = 0.002). Seventy-two percent of patients presented with nonmetastatic disease. Of these, 94% underwent curative surgery, among whom more uLMS patients achieved negative surgical margins (90% vs. 45%, P = 0.003). There were no significant differences in adjuvant therapy use and relapse patterns between uLMS and eLMS. Half of metastatic patients received palliative chemotherapy, among whom 76% received anthracycline-based chemotherapy in first line to which response rate was 31%. Median overall survival was 45.2 months, 49.8 months in uLMS, and 40.5 months in eLMS (P = 0.294). Among patients without metastases, median survival was 60.8 months (77.3 vs. 48.1 mo in uLMS and eLMS, respectively, P = 0.194). In metastatic disease, median survival was 20.7 months (22.0 vs. 17.5 mo in uLMS and eLMS, respectively, P = 0.936). Advanced disease stage, bone metastases and lack of metastasectomy prognosticated for inferior survival.
  
  
  CONCLUSIONS
  While demonstrating interesting clinicopathologic differences, the evidence for uLMS and eLMS being biologically distinct remains inconclusive. Disease stage is prognostically most important in LMS.
authors: Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
authors: Mohamad
authors: M
authors: Farid
authors: Whee Sze
authors: WS
authors: Ong
authors: Mann Hong
authors: MH
authors: Tan
authors: Leon Siang Shen
authors: LS
authors: Foo
authors: Yong Kuei
authors: YK
authors: Lim
authors: Whay Kuang
authors: WK
authors: Chia
authors: Lay Tin
authors: LT
authors: Soh
authors: Donald
authors: D
authors: Poon
authors: Marcus Jin Fu
authors: MJ
authors: Lee
authors: Zhen Chong
authors: ZC
authors: Ho
authors: Raaj
authors: R
authors: Jeevan
authors: Francis
authors: F
authors: Chin
authors: Melissa
authors: M
authors: Teo
authors: Richard
authors: R
authors: Quek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy