title: Clinical outcomes and prognostic markers in uterine leiomyosarcoma: a population-based cohort.
abstract: OBJECTIVE
  The aim was to identify clinical parameters and immunohistochemical markers predictive of recurrence and overall survival (OS) in a community cohort of patients with primary uterine leiomyosarcoma (ULMS).
  
  
  METHODS
  All patients with new diagnosis of ULMS from 1999 to 2007 were identified from the Kaiser Permanente Northern California pathology database. A retrospective chart review was performed to gather demographic and clinical data. The primary outcomes were recurrence-free survival and OS. In addition, a subset of tumor samples was available to analyze 3 immunohistochemical markers using tissue microarray techniques; these are as follows: estrogen receptor (ER) alpha, epidermal growth factor receptor (EGFR), and Ki-67.
  
  
  RESULTS
  Seventy-five patients with ULMS were identified, of which 63 had adequate tumor tissue available for immunohistochemical evaluation. The median follow-up for all stages was 28 months. The rate of recurrence or progressive disease was 76% for stage I patients compared with 85% for stage II to IV patients. At 3 years, 37% of stage I patients were recurrence free compared with 27% of stage II to IV patients. Overall survival for stage I patients declined from 64% to 38% between 3 and 5 years while remaining stable at 30% for stage II to IV patients. In multivariable analysis, increasing mitotic counts were associated with increased risk of recurrence (hazards ratio [HR], 3.2; P = 0.013) and a trend toward decreased OS (HR, 2.2; P = 0.10). Expression of ER (HR, 1.0), EGFR expression (HR, 1.0), and Ki-67 expression (HR, 1.0) were not predictive of recurrence or OS.
  
  
  CONCLUSIONS
  Recurrence rate of 76% for patients with stage I ULMS was higher than previously published cohorts. Mitotic counts were associated with increased recurrence and decreased OS. Expressions of ER, EGFR, and Ki-67 were not useful for predicting overall recurrence or survival.
authors: *Division of Gynecologic Oncology, and †Department of Pathology, The Permanente Medical Group, San Francisco, CA; and ‡Division of Biostatistics, University of California, Berkeley, CA.
authors: Christine
authors: C
authors: Garcia
authors: Jenna S
authors: JS
authors: Kubat
authors: Regan S
authors: RS
authors: Fulton
authors: Adam T
authors: AT
authors: Anthony
authors: Mary
authors: M
authors: Combs
authors: C Bethan
authors: CB
authors: Powell
authors: Ramey D
authors: RD
authors: Littell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007890:Leiomyosarcoma / Q000453:epidemiology / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D046888:Tissue Array Analysis; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor