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Abstract
Introduction/Background In many cases surgery of LMS is performed under the indication of presumed leiomyoma (LM) resulting frequently in morcellation. This study analysed it’s influence on prognosis.
Methodology Investigations included: Kaplan-Meier analysis, age, tumour size, mitosis index, estrogen receptor and 5-year-overall survival prediction. In order to exclude the impact of primary extrauterine spread on prognosis, only LMS stage pT1ab were analysed.
Results From 215 stage pT1ab LMS150 (69.8%) were operated under the indication of LM. In summary, 89 (41.4%) tumors were morcellated. In this group local-relapse-free interval (LFI) was significantly shorter than without morcellation with the highest difference between 2 to 7 years, which becomes irrelevant after 8 years. In contrast, patients with morcellation had a significantly longer distant-metastasis-free interval (MFI). The difference in MFI stayed over the whole-time range without becoming similar to the not morcellated tumours. Considering the latter and the results of the other investigated prognosis factors including the overall survival (OS) probability, the morcellated LMS have had a better prognosis primary. A joint analysis of MFI and LFI (figure 1) showed no differences and the negative effect of morcellation is also after 8 years not relevant. In the same way OS (figure 2) does not change after the morcellation. In conclusion, the primary better prognosis of morcellated LMS becomes identically with the worse prognosis of not morcellated tumours. Additionally, analysis of time from the first locoregional relapse or metastasis to death shows that women with primary local recurrence have a shorter OS.
Conclusion Morcellated vs not morcellated LMS show a significant shorter LFI with significantly longer MFI. Combined LFI and MFI like OS are not affected. Due to morcellation the preoperatively better prognosis of morcellated LMS measured by other prognostic factors equals the worse prognosis to tumors without morcellation.
Disclosure Nothing to disclose.
Joint analysis of MFI and LFI
Overall survival