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Stage-specific survival of patients with uterine leiomyosarcoma: A comparison of FIGO and AJCC staging system

2008; Lippincott Williams & Wilkins; Volume: 26; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2008.26.15_suppl.5554

1527-7755

Oliver Zivanovic, Alexia Iasonos, M. Leitao, Qian Zhou, Robert A. Soslow, Margrit M. Juretzka, D. S., Murray F. Brennan, Martee L. Hensley,

Uterine Myomas and Treatments

5554 Background: Uterine Leiomyosarcoma (LMS) is staged by the modified International Federation of Gynecology and Obstetrics (FIGO) staging system for uterine cancer. We aimed to determine whether the American Joint Committee on Cancer (AJCC) Soft Tissue Sarcoma (STS) Staging System is more predictive of overall-survival (OS). Methods: We analyzed all patients (pts) with uterine LMS who presented at our institution from 1975 to 2005. The pts were staged retrospectively, according to the modification of the FIGO staging system for uterine cancer and the 6th edition of the AJCC STS staging system. OS estimates were determined using Kaplan-Meier method. The predictive accuracy of the two staging systems was compared using concordance estimation. Results: 220 pts had sufficient clinical and pathologic information for staging under both systems. 136 pts were upstaged in the AJCC staging system, whereas only 2 pts were down-staged. 126 patients were classified as FIGO Stage I. Of these, 25 patients were upstaged to AJCC Stage II and 84 to AJCC Stage III. Of 10 FIGO Stage II pts, 9 were AJCC Stage III. Of 33 FIGO Stage III pts 18 were upstaged to AJCC Stage IV and 2 were down-staged to AJCC stages I (low grade LMS) and II (<5cm) respectively. The median follow-up time for the surviving pts was 5.4 years (range: 0.6 to 21.8 years). Stage-specific OS rates for Stage I pts differed substantially between FIGO and AJCC (Table). In both systems there was prognostic overlap between Stages II and III. Thus, despite the marked stage-specific differences in 5-year OS rates for Stage I, the systems had similar concordance indices (0.64 for AJCC; 0.62 for FIGO). Conclusions: Estimates of stage-specific OS for uterine LMS were altered substantially when using AJCC v. FIGO. Adjuvant treatment strategies should be tested in patients at substantial risk for death. Neither FIGO nor AJCC is ideal for identifying such patients suggesting a need for a uterine LMS-specific staging system to better target pts for trials of adjuvant therapies. 5-year overall survival rate Stage FIGO AJCC I 58% (n=126) 94% (n=18) II 43% (n=10) 51% (n=27) III 36% (n=33) 51% (n=106) IV 16% (n=51) 19% (n=69) No significant financial relationships to disclose.