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Clinical Outcomes and Prognostic Markers in Uterine Leiomyosarcoma: A Population-Based Cohort
  1. Christine Garcia, MD*,
  2. Jenna S. Kubat, MD*,
  3. Regan S. Fulton, MD, PhD,
  4. Adam T. Anthony, MS,
  5. Mary Combs, MA,
  6. C. Bethan Powell, MD* and
  7. Ramey D. Littell, MD*
  1. *Division of Gynecologic Oncology, and
  2. Department of Pathology, The Permanente Medical Group, San Francisco, CA; and
  3. Division of Biostatistics, University of California, Berkeley, CA.
  1. Address correspondence and reprint requests to Ramey D. Littell, MD, Division of Gynecologic Oncology, The Permanente Medical Group, 2350 Geary Blvd, San Francisco, CA 94115. E-mail: Ramey.Littell{at}


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/Materials 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.

  • Uterine leiomyosarcoma
  • Radiation
  • Chemotherapy
  • EGFR
  • Estrogen receptor
  • Mitoses

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  • Supported by a community benefit grant from Kaiser Permanente Northern California.

  • The authors declare no conflicts of interest.