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Master Thesis

Étude pronostique de 107 cas de léïomyosarcomes utérins

Abstract : Background. Uterine leiomyosarcomas (LMS) are rare cancers with a difficult, late and fortuitous diagnosis, with a poor prognosis. Surgery is the only validated treatment. The indications for adjuvant therapy are not consensual, and could be improved by a better knowledge of prognostic factors. Objective. To determine clinical and histological prognostic factors associated with uterine LMS. Methods. We performed a retrospective and monocentric study, and collected data from 107 cases of LMS of the uterus at the Bergonié Institute from 1998 to 2018. Kaplan-Meier and Cox methods were used to investigate the prognostic role of the factors selected in survival, time to local progression (TTLP) and time to distant progression (TTDP). Results. Medium age was 58,6 [32-87], 70 patients were menopaused (65%). 31 patients had metastasis at diagnosis. A locoregional recurrence occurred in 32 patients, a metastatic recurrence occurred in 44 patients, 81% of which in the lung. Overall survival was 39,8% at 5 years. Age (p=0,01), uterine morcellation (p=0,005), and FIGO stage (p=0,006) were independent factors for TTLP. Performance Status (p=0,04 and p=0,0005), FIGO stage (p=0,05 and p < 0,0001), and grade (p = 0,02 and p=0,01) were independent factors respectively for TTDP and survival. Conclusion. A high risk of metastasis explains the poor prognosis of uterine LMS. The main prognostic factors for general outcome are stage, age, PS, and grade (FNCLCC), which is not valid for uterine sarcomas, but would deserve more interest in uterine LMS. Uterine morcellation is the main predictive factor for locoregional recurrence, and should be avoid after the menopause.
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Manon Renaudin. Étude pronostique de 107 cas de léïomyosarcomes utérins. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02433537⟩

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