Age-stratified risk of unexpected uterine sarcoma following surgery for presumed benign leiomyoma

Brohl, A. S., Li, L., Andikyan, V., Obican, S. G., Cioffi, A., Hao, K., Dudley, J. T., Ascher-Walsh, C., Kasarskis, A., Maki, R. G. (April 2015) Age-stratified risk of unexpected uterine sarcoma following surgery for presumed benign leiomyoma. Oncologist, 20 (4). pp. 433-9. ISSN 1549-490X (Electronic)1083-7159 (Linking)

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.

Item Type: Paper
Uncontrolled Keywords: Adult Age Factors Aged Female Humans Leiomyoma/*surgery Middle Aged Retrospective Studies Risk Factors Sarcoma/diagnosis/epidemiology/*pathology/surgery Uterine Myomectomy Uterine Neoplasms/diagnosis/epidemiology/*pathology/*surgery Endometrial stromal sarcoma Hysterectomy Leiomyoma Leiomyosarcoma
Subjects: diseases & disorders > cancer > cancer types > sarcoma
CSHL Authors:
Communities: CSHL labs > Maki lab
Depositing User: Matt Covey
Date: April 2015
Date Deposited: 20 Oct 2016 14:41
Last Modified: 20 Oct 2016 14:41
PMCID: PMC4391766
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