Prognosis and Follow-Up Recommendations for Subcutaneous and Dermal Leiomyosarcoma: Local Recurrence, Metastasis, and Overall Survival in a Danish Nationwide Cohort of 661 Patients.

IF 1.9 3区 医学 Q3 ONCOLOGY
Kiya Abebe, Mathias Ørholt, Erik E F Bak, Andreas Larsen, Anne Lene Wagenblast, Grethe Schmidt, David Hebbelstrup Jensen, Michael M Petersen, Anand C Loya, Søren Daugaard, Mikkel Herly, Jason L Hornick, Thomas Mentzel, Peter Vester-Glowinski
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Abstract

Background and objectives: The prognostic differences between subcutaneous leiomyosarcoma and dermal leiomyosarcoma are not well defined due to limited cohort sizes and insufficient follow-up in prior studies. This study aimed to investigate the clinicopathological features of subcutaneous and dermal leiomyosarcoma and estimate their 10-year rates of metastasis, local recurrence, and overall survival. Additionally, we propose standardized follow-up recommendations.

Methods: All patients diagnosed with cutaneous leiomyosarcoma in Denmark from 1980 to 2022 were included. The prognosis was estimated using age- and sex-standardized stratified cause-specific Cox-regression with all-cause mortality as competing risk.

Results: We included 196 patients with subcutaneous leiomyosarcoma and 465 with dermal leiomyosarcoma. The 10-year local recurrence rate was similar in patients with subcutaneous leiomyosarcoma (15%) and dermal leiomyosarcoma (11%, p = 0.13). However, patients with subcutaneous leiomyosarcoma had a significantly higher 10-year risk of metastasis (25%), primarily observed in grade 2 and 3 tumors, compared with dermal leiomyosarcoma (2.7%), p < 0.001, and a lower 10-year-overall survival (56% vs. 64%), p = 0.02.

Conclusions: Grade 2 and 3 subcutaneous leiomyosarcoma should be classified as a high-risk sarcoma with a substantial risk of metastasis and poor overall survival, necessitating follow-up that includes both clinical examinations and PET/CT or CT of the thorax for 5 years to detect both locoregional and distant metastases. Dermal leiomyosarcoma should be considered a low-risk sarcoma due to its low risk of metastasis and moderate risk of local recurrence, suggesting that the follow-up can focus on clinical examinations for 4 years as the 10-year risk of local recurrence is < 1% after this time point.

对皮下和真皮平滑肌肉瘤的预后和随访建议:丹麦全国661例患者的局部复发、转移和总生存率。
背景和目的:由于先前研究的队列规模有限和随访不足,皮下平滑肌肉瘤和真皮平滑肌肉瘤的预后差异尚未得到很好的界定。本研究旨在探讨皮下和真皮平滑肌肉瘤的临床病理特征,并估计其10年转移率、局部复发率和总生存率。此外,我们还提出了标准化的后续建议。方法:纳入1980年至2022年丹麦所有诊断为皮肤平滑肌肉瘤的患者。预后评估采用年龄和性别标准化分层病因特异性cox回归,全因死亡率作为竞争风险。结果:我们纳入196例皮下平滑肌肉瘤和465例真皮平滑肌肉瘤。皮下平滑肌肉瘤患者的10年局部复发率为15%,真皮平滑肌肉瘤患者的10年局部复发率为11%,p = 0.13。然而,与真皮平滑肌肉瘤(2.7%)相比,皮下平滑肌肉瘤患者的10年转移风险(25%)明显更高,主要发生在2级和3级肿瘤中。2级和3级皮下平滑肌肉瘤应归类为高风险肉瘤,转移风险大,总体生存率差,需要随访5年,包括临床检查和PET/CT或胸部CT,以发现局部和远处转移。真皮平滑肌肉瘤转移风险低,局部复发风险中等,属于低风险肉瘤,建议随访4年以临床检查为主,局部复发风险为10年
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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