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Hormone receptor status and the role of oophorectomy in uterine leiomyosarcoma

  • Emily Hinchcliff
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Northwestern University Feinberg, School of Medicine and Robert H. Lurie Comprehensive Cancer Center, 250 E. Superior Street, Suite 420, Chicago, IL 60611, United States of America.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, United States of America
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  • Jennifer Rumpf
    Affiliations
    Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX, United States of America
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  • Ravin Ratan
    Affiliations
    Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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  • Nicole D. Fleming
    Affiliations
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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  • Amir Jazaeri
    Affiliations
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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  • Bryan Fellman
    Affiliations
    Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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  • Larissa Meyer
    Affiliations
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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  • Pamela Soliman
    Affiliations
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Published:October 18, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.09.024

      Highlights

      • Oophorectomy for ULMS did not influence survival in the overall cohort.
      • In ULMS with uterine confined disease, oophorectomy still did not impact survival.
      • Hormone receptor status did not impact survival in ULMS, even among those with ovaries left in situ.

      Abstract

      Objective

      Uterine leiomyosarcoma (ULMS) is an aggressive malignancy for which hysterectomy is often the primary treatment approach. Due to the rarity of these tumors, the role of oophorectomy in the management of ULMS is not clearly established. This study aimed to describe the impact of oophorectomy and estrogen/progesterone (ER/PR) receptor status on clinical outcomes and survival.

      Methods

      Women with ULMS treated between 1/2013 and 1/2018 were retrospectively identified. Clinical data was collected; descriptive statistics were performed and predictors of overall survival (OS) and event free survival (EFS) were analyzed using Cox regression and Kaplan-Meier methodology.

      Results

      189 patients were included. Median age was 53 years (20–84 years). The majority of patients had stage IB (58%) and grade 3 (94%) tumors. On pathologic analysis, ER/PR expression was positive in 41% and 33%, respectively. The majority of patients (179, 94.7%) underwent surgery as their primary treatment approach, of which 51 (28.5%) had ovarian conservation. 59.0% were treated with chemotherapy, while 9.9% received radiation therapy. 84.6% of patients experienced a recurrence, but there was no difference in EFS or OS by oophorectomy status, including among those with uterine confined disease. Additionally, ER/PR status was not independently associated with EFS/OS (p = 0.14, p = 0.07) nor did it impact survival among those with ovaries left in situ.

      Conclusions

      Oophorectomy did not influence OS, even though many tumors were hormone receptor positive. ER/PR status was not independently associated with survival, including in the subset of women with uterine confined disease and those who had undergone oophorectomy.

      Keywords

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