Age-Stratified Predictive Model May Provide Surgical Guidelines for Uterine Leiomyomas
A study by Brohl et al investigating the case incidence of unexpected uterine sarcoma following surgery for presumed benign leiomyoma (fibroids or myomas) has found that the risk of unexpected uterine sarcoma varies significantly across age groups, with a more than fivefold difference between the highest and lowest risk age groups. The age-stratified predictive model can be used to more accurately counsel patients and to assist in providing surgical guidelines for the removal of leiomyoma. The study is published in The Oncologist.
Study Methodology
The researchers used data from the Mount Sinai Data Warehouse (MSDW) to conduct a retrospective analysis of 2,075 women who had undergone myomectomy for presumed benign leiomyoma at Mount Sinai Hospital and Mount Sinai Faculty Practice Associates in New York City between 2005 and 2014. An aggregate risk estimate was generated using a meta-analysis of similar studies plus the researchers’ data. Database-derived age distributions of the incidence rates of uterine sarcoma and uterine leiomyoma surgery were used to stratify risk by age.
Study Findings
Of the 2,075 patients in the retrospective cohort, six were diagnosed with uterine sarcoma. The researchers’ meta-analysis revealed eight studies from 1980 to 2014. In a total sample of 10,120 patients, 18 cases of leiomyosarcoma were reported 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 researchers reported 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, the researchers 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.
Clinical Implications
The study findings, concluded the researchers, represents an advancement to better define the risk of unexpected uterine sarcoma in the setting of surgery for presumed benign leiomyoma.
“Our age-stratified predictive model may be incorporated to more accurately counsel patients in clinical practice and to assist in providing guidelines for the surgical technique for leiomyoma. Future studies on this topic should be undertaken to confirm our findings, to investigate the use of additional stratification variables, and to incrementally improve on our estimates,” wrote the researchers.
Andrew S. Brohl, MD, of the Icahn School of Medicine at Mount Sinai, is the corresponding author of this study.
Funding for this study was provided by the National Institutes of Health and the Icahn School of Medicine at Mount Sinai.
Joel T. Dudley, PhD, is a consultant for Ayasdi, Inc; has received honoraria from Roche, AstraZeneca, and GlaxoSmithKline; has received funding from Janssen Pharmaceuticals; and has ownership interests in NuMedii. The other study authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
