Comparison of different staging systems for high-grade uterine leiomyosarcoma

Abstract

Introduction/Background The International Federation of Gynecology and Obstetrics (FIGO) had developed a staging system specific to each type of uterine sarcoma in 2009. American Joint Committee on Cancer (AJCC) also has another staging system for soft tissue sarcoma. However there were limited data to validate these systems due to the rarity of the tumor. Even among uterine leiomyosarcoma (uLMS), the clinical behaviors differ between high-grade and low-grade disease. Methodology Patients with uLMS diagnosed in Jrun 1993 - Jan 2014 were identified. All specimens were reviewed by gynecologic pathologists using the World Health Organization diagnostic criteria. Survival and recurrence status were recorded from the medical records. Results 142 high-grade uLMS patients had enough information for analysis. The median follow-up of the whole cohort was 36 months (inter-quartile range 13–77 months). In terms of progression-free survival (PFS) and overall survival (OS), both the 1988 FIGO and AJCC staging systems could classify patients into four distinct groups, while patients with stage 2 in the 2009 FIGO staging system had a worse prognosis compared to stage 3 (table 1, figure 1). And neither of the two FIGO staging systems could categorize the patients meaningfully according to their sub-stages (table 2). In addition, patients are early stage, regardless of the staging systems, had a high recurrence rate up to 50% (table 1). Conclusion None of the staging systems could accurately predict the patients‘ outcomes according to their stages. Further collaborative studies are needed in order to establish a better staging system to predict the prognosis and guide the adjuvant of the patients.