Prognostic factors in prostatic leiomyosarcoma: a pooled analysis of 143 reported cases

Prostatic leiomyosarcoma is a rare and aggressive malignancy with limited prognostic data. We performed a pooled analysis of 143 cases from 82 published reports to identify key prognostic markers.

The median age at diagnosis was 57 years (interquartile range [IQR] 22.5 years), and the median tumor size was 8 cm (IQR 7 cm). Spindle cell morphology was the predominant histologic subtype, observed in 48.3% of cases, with 80.1% of tumors classified as high-grade. Metastasis was present in 37.2% of patients, recurrence was present in 25.9%, and the overall mortality rate was 57.2%. Kaplan-Meier survival analysis demonstrated significantly reduced survival in patients with metastasis (13 vs 32 months, P = 0.04), mixed histology (5 vs 27 months, P = 0.04), positive surgical margins (15 vs 29 months, P = 0.02), and elevated prostate-specific antigen levels (>4 ng/mL) (3 vs 27 months, P = 0.04). The median overall survival was 25 months (95% confidence interval [CI]: 14.96-35.04). Multivariate Cox regression analysis identified metastasis as a significant predictor of mortality (hazard ratio [HR] = 3.66, P = 0.02). Additionally, multivariate logistic regression analysis revealed tumor recurrence as an independent predictor of mortality (odds ratio [OR] = 3.41, P = 0.01). Chi-square/Fisher's exact tests indicated a significant association between metastasis and recurrence (P = 0.002) and between spindle morphology and metastatic risk (P = 0.04). Moreover, recurrence was strongly associated with mortality (P = 0.002).

Metastasis and tumor recurrence are key predictors of mortality in prostatic leiomyosarcoma.