Open AccessUterine Leiomyosarcoma in Asian Patients: Validation of the Revised Federation of Gynecology and Obstetrics Staging System and Identification of Prognostic Classifiers
Author(s) -
Tan PeiShan,
Koh Elisa,
Pang Cindy,
Ong WheeSze,
Ngo Lynette,
Soh LayTin,
Quek Richard,
Chay WenYee,
Ho TewHong,
Tay SunKuie,
Chew SungHock,
LimTan SooKim,
KhooTan Hs,
Lim Sheow Lei,
Busmanis Inny,
Goh Liang Kee,
Chia YinNin,
Chia WhayKuang,
Lim Timothy
Publication year - 2012
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2012-0124
Subject(s) - medicine , concordance , stage (stratigraphy) , gynecology , obstetrics and gynaecology , obstetrics , proportional hazards model , lymphovascular invasion , pregnancy , cancer , metastasis , genetics , biology , paleontology
Learning Objectives After completing this course, the reader will be able to: Describe the ability of the revised 2008 FIGO staging system to determine risk strata in patients with uterine leiomyosarcoma. Compare concordance indices of the older and the revised FIGO staging systems. Identify gaps in the current FIGO staging system.This article is available for continuing medical education credit at CME.TheOncologist.comBackground. In 2008, the Federation of Gynecology and Obstetrics (FIGO) revised their 1988 staging system for uterine leiomyosarcomas. In this article, we compare performance of the 2008 and 1988 FIGO systems. Methods. Individual case data were manually culled. Staging was retrospectively assessed according to revised and 1998 FIGO criteria. Overall survival distribution was assessed by the Kaplan‐Meier method. Harrell's concordance index was used to assess the discriminative ability of a fitted Cox model to predict overall survival. Results. A total of 110 cases of uterine leiomyosarcomas were reviewed and data from 88 patients were analyzed. In all, 71% of cases were classified as stage I, 7% as stage II, 3% as stage III, and 19% as stage IV under the revised FIGO staging system. Nine patients (10.2%) were downstaged and none were upstaged. The revised FIGO system did not show a significant improvement over the 1988 FIGO system in the ability to discriminate the risk of death of patients between stages, with concordance indexes of 0.70 and 0.71, respectively. Most patients were classified as stage I with age, tumor grade, tumor size, and lymphovascular invasion as prognostic factors. Conclusion. The 2008 revised FIGO staging system for uterine leiomyosarcomas does not perform better than the 1988 system for uterine endometrial carcinomas. A better staging system is needed for these cases.