title: Metastatic pattern of uterine leiomyosarcoma: retrospective analysis of the predictors and outcome in 113 patients.
abstract: OBJECTIVE
  To describe metastatic pattern of uterine leiomyosarcomas (ULMS) and correlate it with clinical and histopathologic parameters.
  
  
  METHODS
  We included 113 women (mean age, 53 years; range, 29 to 72 years) with histopathology-confirmed ULMS from 2000 to 2012. Distribution of metastases was noted from imaging by two radiologists in consensus. Predictors of development of metastases were analyzed with univariate and multivariate analysis. Impact of various clinical and histopathologic parameters on survival was compared using Log-rank test and Cox proportional hazard regression model.
  
  
  RESULTS
  Distant metastases were seen in 81.4% (92/113) of the patients after median interval of 7 months (interquartile range, 1 to 21). Lung was most common site of metastases (74%) followed by peritoneum (41%), bones (33%), and liver (27%). Local tumor recurrence was noted in 57 patients (50%), 51 of whom had distant metastases. Statistically significant correlation was noted between local recurrence and peritoneal metastases (p<0.001) and between lung and other common sites of hematogeneous metastases (p<0.05). Age, serosal involvement, local recurrence, and the International Federation of Gynecology and Obstetrics (FIGO) stage were predictive factors for metastases. At the time of reporting, 65% (74/113) of the patients have died; median survival was 45 months. Stage, local recurrence, and age were poor prognostic factors.
  
  
  CONCLUSIONS
  ULMS metastasizes most frequently to lung, peritoneum, bone, and liver. Local recurrence was associated with peritoneal spread and lung metastases with other sites of hematogeneous metastases. Age, FIGO stage and local recurrence predicted metastatic disease and advanced stage, older age and local recurrence predicted poor outcome.
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. stirumani@partners.org.
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Deaver
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Atul B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: Harika
authors.initials: H
authors.lastname: Tirumani
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.affiliation: Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Nikhil H
authors.initials: NH
authors.lastname: Ramaiya
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology* / Q000628:therapy
keywords: Leiomyosarcoma; Neoplasm recurrence; Prognosis; Proportional Hazards Models