Prognostic factors and optimal management approaches for stage IB uterine leiomyosarcoma: a retrospective analysis

Early-stage uterine leiomyosarcoma (uLMS) remains a clinical challenge due to high recurrence and mortality rates. As most early-stage cases are diagnosed at stage IB, this study aims to investigate the prognostic factors and optimal management for stage IB uLMS.

A retrospective review was conducted of medical records for patients who underwent surgical intervention and were diagnosed with stage IB uLMS at the Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center from January 1, 2006, to August 31, 2023.

After a median follow-up time of 70.1 months (range: 2.3-234.1), we observed a median disease-free survival (DFS) of 18 months and overall survival (OS) of 67.9 months, respectively. Median DFS was 14.7 months in the observation group and 18.4 months in the adjuvant chemotherapy group. Median OS was 75.4 months in the observation group and 66.6 months in the adjuvant chemotherapy group. Five-year DFS rates were 14.1% and 15.7%, and OS rates were 66.5% and 54.1% for the observation and chemotherapy groups, respectively. Poor DFS was associated with age >48 years, postmenopausal status, tumor size >12 cm, elevated Ki-67 levels, and lymphadenectomy, but these factors did not correlate with OS outcomes. No significant DFS or OS differences were found between chemotherapy and observation groups or across chemotherapy regimens. Ovarian preservation did not affect prognosis.

Age >48 years, postmenopausal status, larger tumor size, higher Ki-67, and lymphadenectomy predicted poor DFS but not OS in stage IB uLMS. Ovarian preservation is safe. Adjuvant chemotherapy with different regimens showed no significant survival benefits.