Abstract：
METHODS: Uterine leiomyosarcomas (uLMS) are rare malignant tumors, often incidentally discovered, with an estimated annual incidence of five cases per one million women in the United States. This study aimed to compare the oncological outcomes of two groups of patients: those with uLMS incidentally found during surgery and those who underwent surgery due to suspected or confirmed uLMS before the procedure. The study assessed patients who had undergone hysterectomy and were diagnosed with stage I uLMS at a tertiary gynecologic oncology referral center in Italy between January 2000 and December 2019. Data on patients\' baseline characteristics, surgical procedures, and oncological outcomes were collected. The patients were classified into two groups based on whether uLMS was unexpectedly discovered or suspected before the surgery. Survival rates and factors influencing recurrence were analyzed.
RESULTS: The study included 36 patients meeting the inclusion criteria, with 12 having preoperatively suspected or proven uLMS and 24 having incidentally discovered uLMS. No significant differences were observed between the two groups regarding disease-free survival (23.7 vs. 27.3 months, log rank = 0.28), disease-specific survival (median not reached, log rank = 0.78), or sites of relapse. Notably, among patients who underwent laparoscopic hysterectomy (compared to open surgery), a significantly higher rate of locoregional recurrence was found (78% vs. 33.3%, p = 0.04). Nevertheless, no significant differences in survival were observed based on the surgical approach.
CONCLUSIONS: Preoperative suspicion for uLMS did not seem to impact survival outcomes or the pattern of recurrence. Furthermore, although patients who underwent laparoscopic hysterectomy showed a higher rate of locoregional relapse, this did not affect their overall survival.
RESULTS: The study included 36 patients meeting the inclusion criteria, with 12 having preoperatively suspected or proven uLMS and 24 having incidentally discovered uLMS. No significant differences were observed between the two groups regarding disease-free survival (23.7 vs. 27.3 months, log rank = 0.28), disease-specific survival (median not reached, log rank = 0.78), or sites of relapse. Notably, among patients who underwent laparoscopic hysterectomy (compared to open surgery), a significantly higher rate of locoregional recurrence was found (78% vs. 33.3%, p = 0.04). Nevertheless, no significant differences in survival were observed based on the surgical approach.
CONCLUSIONS: Preoperative suspicion for uLMS did not seem to impact survival outcomes or the pattern of recurrence. Furthermore, although patients who underwent laparoscopic hysterectomy showed a higher rate of locoregional relapse, this did not affect their overall survival.
摘要：
方法：子宫平滑肌肉瘤（uLMS）是一种罕见的恶性肿瘤，经常偶然发现，在美国，估计每年发病率为每100万女性5例。这项研究旨在比较两组患者的肿瘤学结果：在手术期间偶然发现uLMS的患者和在手术前由于怀疑或确认uLMS而接受手术的患者。该研究评估了2000年1月至2019年12月在意大利三级妇科肿瘤转诊中心接受子宫切除术并被诊断为I期uLMS的患者。患者基线特征数据，外科手术,并收集肿瘤结果。根据手术前是否意外发现或怀疑uLMS将患者分为两组。分析生存率及影响复发的因素。
结果：该研究包括36名符合纳入标准的患者，12例术前怀疑或证实uLMS，24例偶然发现uLMS。两组之间在无病生存率方面没有观察到显着差异（23.7vs.27.3个月，logrank=0.28)，疾病特异性生存率(中位数未达到，logrank=0.78)，或复发部位。值得注意的是,在接受腹腔镜子宫切除术（与开腹手术相比）的患者中，发现局部复发率明显较高(78%vs.33.3%,p=0.04)。然而，根据手术入路,生存率无显著差异.
结论：术前怀疑uLMS似乎并不影响生存结果或复发模式。此外，尽管接受腹腔镜子宫切除术的患者显示出更高的局部复发率，这并不影响他们的总生存期.
结果：该研究包括36名符合纳入标准的患者，12例术前怀疑或证实uLMS，24例偶然发现uLMS。两组之间在无病生存率方面没有观察到显着差异（23.7vs.27.3个月，logrank=0.28)，疾病特异性生存率(中位数未达到，logrank=0.78)，或复发部位。值得注意的是,在接受腹腔镜子宫切除术（与开腹手术相比）的患者中，发现局部复发率明显较高(78%vs.33.3%,p=0.04)。然而，根据手术入路,生存率无显著差异.
结论：术前怀疑uLMS似乎并不影响生存结果或复发模式。此外，尽管接受腹腔镜子宫切除术的患者显示出更高的局部复发率，这并不影响他们的总生存期.
