title: Clinical outcomes of women with recurrent or persistent uterine leiomyosarcoma.
abstract: OBJECTIVE
  This study aimed to identify prognostic factors influencing the outcome of recurrent or persistent uterine leiomyosarcoma (ULMS).
  
  
  METHODS
  All patients with recurrent or persistent ULMS who underwent treatment at the participating institutions between January 2000 and December 2010 were identified from the tumor registry. The Kaplan-Meier method was used to generate overall survival data. Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model.
  
  
  RESULTS
  One hundred fifteen (68.8%) patients who had recurrent/persistent disease were identified, 40 (34.8%) had persistent disease, and 75 (65.2%) had a recurrence. Median follow-up time was 24.9 months. The 5-year postrelapse survival rate was 15% and was not significantly different between women with recurrent or persistent disease (16% vs 13%; P = 0.1). Variables identified affecting the 5-year postrelapse survival rate included low number of mitosis at the time of diagnosis (<25, 25% vs 5%; P = 0.002), time to relapse from original diagnosis (≤6 vs >6 months, 8% vs 22%; P = 0.003)), and surgical treatment (17% vs 12%; P = 0.01). Age, stage, chemotherapy at time of original diagnosis or at the time of relapse, site of recurrence, and single versus multiple sites of recurrence were not associated with survival. In a multivariate Cox regression model, only low number of mitosis (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8, P = 0.02) was identified as a predictor of overall survival.
  
  
  CONCLUSIONS
  The prognosis of patients with recurrent/persistent ULMS is, in general, poor. Women who have low number of mitosis at the time of diagnosis seemed to have better postrelapse survival.
authors.affiliation: *Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, †Division of Gynecologic Oncology, Brigham and Women's Hospital, and ‡Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Jose Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Emily M
authors.initials: EM
authors.lastname: Hinchcliff
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Worley
authors.forename: Carolina A
authors.initials: CA
authors.lastname: Andrade
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.forename: Micheal G
authors.initials: MG
authors.lastname: Muto
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D017211:Treatment Failure; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology