Age‐Stratified Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma

• Published in: The oncologist (Dayton, Ohio) Vol. 20; no. 4; pp. 433 - 439
• Main Authors: Brohl, Andrew S., Li, Li, Andikyan, Vaagn, Običan, Sarah G., Cioffi, Angela, Hao, Ke, Dudley, Joel T., Ascher‐Walsh, Charles, Kasarskis, Andrew, Maki, Robert G.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.04.2015
• Subjects: Adult; Age Factors; Aged; Endometrial stromal sarcoma; Female; Humans; Hysterectomy; Leiomyoma; Leiomyoma - surgery; Leiomyosarcoma; Middle Aged; Retrospective Studies; Risk Factors; Sarcoma - diagnosis; Sarcoma - epidemiology; Sarcoma - pathology; Sarcoma - surgery; Sarcomas; Uterine Myomectomy; Uterine Neoplasms - diagnosis; Uterine Neoplasms - epidemiology; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery; Leiomyoma; Hysterectomy; Endometrial stromal sarcoma; Uterine myomectomy; Leiomyosarcoma
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2014-0361

Background. Estimates of unexpected uterine sarcoma following surgery for presumed benign leiomyoma that use age‐stratification are lacking. Patients and Methods. A retrospective cohort of 2,075 patients that had undergone myomectomy was evaluated to determine the case incidence of unexpected uterine sarcoma. An aggregate risk estimate was generated using a meta‐analysis of similar studies plus our data. Database‐derived age distributions of the incidence rates of uterine sarcoma and uterine leiomyoma surgery were used to stratify risk by age. Results. Of 2,075 patients in our retrospective cohort, 6 were diagnosed with uterine sarcoma. Our meta‐analysis revealed 8 studies from 1980 to 2014. Combined with our study, 18 cases of leiomyosarcoma are reported in 10,120 patients, for an aggregate risk of 1.78 per 1,000 (95% confidence interval [CI]: 1.1–2.8) or 1 in 562. Eight cases of other uterine sarcomas were reported in 6,889 patients, for an aggregate risk of 1.16 per 1,000 (95% CI: 0.5–4.9) or 1 in 861. The summation of these risks gives an overall risk of uterine sarcoma of 2.94 per 1,000 (95% CI: 1.8–4.1) or 1 in 340. After stratification by age, we predict the risk of uterine sarcoma to range from a peak of 10.1 cases per 1,000, or 1 in 98, for patients aged 75–79 years to <1 case per 500 for patients aged <30 years. Conclusion. The risk of unexpected uterine sarcoma varies significantly across age groups. Our age‐stratified predictive model should be incorporated to more accurately counsel patients and to assist in providing guidelines for the surgical technique for leiomyoma. Significant controversy about the use of minimally invasive procedures for leiomyoma removal currently exists because of the potential risk of dissemination of unexpected sarcoma. The results of this study show that the risk of unexpected uterine sarcoma is projected to vary significantly by age. The proposed predictive model should be used by clinicians to counsel patients and to assist in providing guidelines for the surgical technique for leiomyoma.