title: Age-stratified risk of unexpected uterine sarcoma following surgery for presumed benign leiomyoma.
abstract: BACKGROUND
  Estimates of unexpected uterine sarcoma following surgery for presumed benign leiomyoma that use age-stratification are lacking.
  
  
  METHODS
  A retrospective cohort of 2,075 patients that had undergone myomectomy was evaluated to determine the case incidence of unexpected uterine sarcoma. An aggregate risk estimate was generated using a meta-analysis of similar studies plus our data. Database-derived age distributions of the incidence rates of uterine sarcoma and uterine leiomyoma surgery were used to stratify risk by age.
  
  
  RESULTS
  Of 2,075 patients in our retrospective cohort, 6 were diagnosed with uterine sarcoma. Our meta-analysis revealed 8 studies from 1980 to 2014. Combined with our study, 18 cases of leiomyosarcoma are reported in 10,120 patients, for an aggregate risk of 1.78 per 1,000 (95% confidence interval [CI]: 1.1-2.8) or 1 in 562. Eight cases of other uterine sarcomas were reported in 6,889 patients, for an aggregate risk of 1.16 per 1,000 (95% CI: 0.5-4.9) or 1 in 861. The summation of these risks gives an overall risk of uterine sarcoma of 2.94 per 1,000 (95% CI: 1.8-4.1) or 1 in 340. After stratification by age, we predict the risk of uterine sarcoma to range from a peak of 10.1 cases per 1,000, or 1 in 98, for patients aged 75-79 years to <1 case per 500 for patients aged <30 years.
  
  
  CONCLUSIONS
  The risk of unexpected uterine sarcoma varies significantly across age groups. Our age-stratified predictive model should be incorporated to more accurately counsel patients and to assist in providing guidelines for the surgical technique for leiomyoma.
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA andrew.brohl@mssm.edu.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Brohl
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Vaagn
authors.initials: V
authors.lastname: Andikyan
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Običan
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Cioffi
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Hao
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Dudley
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Ascher-Walsh
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kasarskis
authors.affiliation: Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Division of Hematology and Medical Oncology, Department of Medicine, and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maki
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*
keywords: Endometrial stromal sarcoma; Hysterectomy; Leiomyoma; Leiomyosarcoma; Uterine myomectomy