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Prognostic Factors in Early-Stage Leiomyosarcoma of the Uterus
  1. Manuela Pelmus, MD, PhD*,
  2. Frédérique Penault-Llorca, MD, PhD,
  3. Louis Guillou, MD,
  4. Françoise Collin, MD§,
  5. Gérard Bertrand, MD,
  6. Martine Trassard, MD,
  7. Agnès Leroux, MD**,
  8. Anne Floquet, MD,,
  9. Eberhard Stoeckle, MD,,
  10. Laurence Thomas§§ and
  11. Gaëtan MacGrogan, MD∥∥
  1. * Department of Pathology, University Hospital of Sherbrooke, Quebec, Canada;
  2. Department of Pathology, Centre Jean Perrin, Clermont Ferrand, France;
  3. Institut Universitaire de Pathologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
  4. § Department of Pathology, Centre Georges François Leclerc, Dijon, France;
  5. Department of Pathology, Centre Paul Papin, Angers, France;
  6. Department of Pathology, Centre René Huguenin, St Cloud, France;
  7. ** Department of Pathology, Centre Alexis Vautrin, Nancy, France; and Departments of
  8. †† Medical Oncology,
  9. ‡‡ Surgery,
  10. §§ Radiotherapy and
  11. ∥∥ Pathology, Institut Bergonié, Bordeaux, France.
  1. Address correspondence and reprint requests to Gaëtan MacGrogan, MD, Département de Pathologie, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux Cedex, France. E-mail: macgrogan{at}


Uterine leiomyosarcomas (LMSs) are rare cancers representing less than 1% of all uterine malignancies. Clinical International Federation of Gynecology and Obstetrics (FIGO) stage is the most important prognostic factor. Other significant prognostic factors, especially for early stages, are difficult to establish because most of the published studies have included localized and extra-pelvian sarcomas. The aim of our study was to search for significant prognostic factors in clinical stage I and II uterine LMS. The pathologic features of 108 uterine LMS including 72 stage I and II lesions were reviewed using standardized criteria. The prognostic significance of different pathologic features was assessed. The median follow-up in the whole group was 64 months (range, 6-223 months). The 5-year overall survival (OS) and metastasis-free interval and local relapse-free interval rates in the whole group and early-stage group (FIGO stages I and II) were 40% and 57%, 42% and 50%, 56% and 62%, respectively. Clinical FIGO stage was the most important prognostic factor for OS in the whole group (P = 4 × 10−15). In the stage I and II group, macroscopic circumscription was the most significant factor predicting OS (P = 0.001). In the same group, mitotic score and vascular invasion were associated with metastasis-free interval (P = 0.03 and P = 0.04, respectively). Uterine LMSs diagnosed using standardized criteria have a poor prognosis, and clinical FIGO stage is an ominous prognostic factor. In early-stage LMS, pathologic features such as mitotic score, vascular invasion, and tumor circumscription significantly impact patient outcome.

  • Leiomyosarcoma
  • Uterus
  • FIGO stage
  • Prognosis

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