Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival
<b>Background:</b> Uterine leiomyosarcoma (LMS) is a rare entity amongst malignant gynaecological tumours and is mostly diagnosed after surgery for benign leiomyoma (LM) of the uterus. As minimal invasive surgery is widely used, the morcellation of LM and the uterus is rather common. As...
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/2/591 |
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| author | Verena M. C. Reichert Zaher Alwafai Marek T. Zygmunt Marcus Vollmer Günter Köhler |
| author_facet | Verena M. C. Reichert Zaher Alwafai Marek T. Zygmunt Marcus Vollmer Günter Köhler |
| author_sort | Verena M. C. Reichert |
| collection | DOAJ |
| description | <b>Background:</b> Uterine leiomyosarcoma (LMS) is a rare entity amongst malignant gynaecological tumours and is mostly diagnosed after surgery for benign leiomyoma (LM) of the uterus. As minimal invasive surgery is widely used, the morcellation of LM and the uterus is rather common. As there is little known about the impact of the morcellation of LMS on local and distant metastases, as well as overall survival, we carried out a large-scale retrospective study. <b>Methods:</b> A total of 301 LMS cases from the German Clinical Competence Centre for Genital Sarcomas and Mixed Tumours were analysed. We distinguished morcellated and non-morcellated LMS from pT1 and >pT1 tumours. Fine–Gray competing risks regressions and cumulative incidence rates were computed for the time to local recurrence, distant metastases, and patient death. <b>Results:</b> The recurrence free interval in pT1 LMS was significantly lower in the morcellation group with a 2-year cumulative incidence rate of 49% vs. 26% in non-morcellated LMS (<i>p</i> = 0.001). No differences were seen in >pT1 tumours. Distant metastases were more frequently found in non-morcellated pT1 LMS compared to the morcellated cases (5-year cumulative incidence: 54% vs. 29%, <i>p</i> < 0.001). There was no significant difference in time to death between both groups neither in the pT1 stages nor in >pT1 disease. Subdistribution hazard ratios estimated by multivariable competing risks regressions for the morcellation of pT1 LMS were 2.11 for local recurrence (95% CI 1.41–3.16, <i>p</i> < 0.001) and 0.52 for distant metastases (95% CI 0.32–0.84, <i>p</i> = 0.008). <b>Conclusions:</b> Tumour morcellation is not associated with OS for pT1 tumours. The morcellation of pT1 LMS seems to prolong the time to distant metastases whereas local recurrence is more likely to occur after the morcellation of pT1 LMS. |
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| issn | 2077-0383 |
| language | English |
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| spelling | doaj.art-202c2e2a59b74b0fb9c8612eb012d52b2023-11-30T22:52:03ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112259110.3390/jcm12020591Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall SurvivalVerena M. C. Reichert0Zaher Alwafai1Marek T. Zygmunt2Marcus Vollmer3Günter Köhler4Department of Obstetrics and Gynaecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, GermanyDepartment of Obstetrics and Gynaecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, GermanyDepartment of Obstetrics and Gynaecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, GermanyInstitute of Bioinformatics, University Medicine Greifswald, Felix-Hausdorff-Str. 8, 17475 Greifswald, GermanyDepartment of Obstetrics and Gynaecology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany<b>Background:</b> Uterine leiomyosarcoma (LMS) is a rare entity amongst malignant gynaecological tumours and is mostly diagnosed after surgery for benign leiomyoma (LM) of the uterus. As minimal invasive surgery is widely used, the morcellation of LM and the uterus is rather common. As there is little known about the impact of the morcellation of LMS on local and distant metastases, as well as overall survival, we carried out a large-scale retrospective study. <b>Methods:</b> A total of 301 LMS cases from the German Clinical Competence Centre for Genital Sarcomas and Mixed Tumours were analysed. We distinguished morcellated and non-morcellated LMS from pT1 and >pT1 tumours. Fine–Gray competing risks regressions and cumulative incidence rates were computed for the time to local recurrence, distant metastases, and patient death. <b>Results:</b> The recurrence free interval in pT1 LMS was significantly lower in the morcellation group with a 2-year cumulative incidence rate of 49% vs. 26% in non-morcellated LMS (<i>p</i> = 0.001). No differences were seen in >pT1 tumours. Distant metastases were more frequently found in non-morcellated pT1 LMS compared to the morcellated cases (5-year cumulative incidence: 54% vs. 29%, <i>p</i> < 0.001). There was no significant difference in time to death between both groups neither in the pT1 stages nor in >pT1 disease. Subdistribution hazard ratios estimated by multivariable competing risks regressions for the morcellation of pT1 LMS were 2.11 for local recurrence (95% CI 1.41–3.16, <i>p</i> < 0.001) and 0.52 for distant metastases (95% CI 0.32–0.84, <i>p</i> = 0.008). <b>Conclusions:</b> Tumour morcellation is not associated with OS for pT1 tumours. The morcellation of pT1 LMS seems to prolong the time to distant metastases whereas local recurrence is more likely to occur after the morcellation of pT1 LMS.https://www.mdpi.com/2077-0383/12/2/591leiomyosarcomamalignancymorcellementrecurrencesurvival |
| spellingShingle | Verena M. C. Reichert Zaher Alwafai Marek T. Zygmunt Marcus Vollmer Günter Köhler Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival Journal of Clinical Medicine leiomyosarcoma malignancy morcellement recurrence survival |
| title | Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival |
| title_full | Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival |
| title_fullStr | Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival |
| title_full_unstemmed | Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival |
| title_short | Accidental Morcellation of Uterine Leiomyosarcoma Influences Relapse Free Survival but Does Not Negatively Influence Overall Survival |
| title_sort | accidental morcellation of uterine leiomyosarcoma influences relapse free survival but does not negatively influence overall survival |
| topic | leiomyosarcoma malignancy morcellement recurrence survival |
| url | https://www.mdpi.com/2077-0383/12/2/591 |
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