Press Release

New Model Predicts Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma

DURHAM, N.C., March 12, 2015 /PRNewswire-iReach/ -- In a study published in The Oncologist on March 12, 2015, researchers describe the development of a new model that predicts the risk of unexpected uterine sarcoma in women undergoing minimally invasive procedures for the removal of presumed benign leiomyoma.

Although minimally invasive techniques are widely used for the surgical management of uterine leiomyoma, there is significant controversy regarding the use of morcellation to remove bulky tumors laparoscopically. Uterine sarcomas are often discovered incidentally after the surgical removal of a mass that is presumed benign. In these cases, there is some concern that morcellation can unintentionally disseminate malignant tissue throughout the peritoneum. To date, however, estimates of the risk of unexpected uterine sarcoma have lacked precision.

To help quantify this risk, a team of researchers led by Andrew S. Brohl, MD, at the Icahn School of Medicine at Mount Sinai in New York, NY, retrospectively evaluated the incidence of unexpected uterine sarcoma among women undergoing minimally invasive leiomyoma removal at Mount Sinai facilities since 2005. The research team also conducted a meta-analysis by pooling their findings with those of similar studies conducted between 1980 and 2014.

“Our study represents an advancement in the understanding of the risk of unexpected uterine sarcoma in the setting of surgery for presumed benign leiomyoma,” Dr. Brohl said. “Importantly, our risk model is the first to take into account how much a patient’s age affects her risk and shows that some age groups are at a much higher risk for unexpected uterine sarcoma than previous estimates imply.” In addition, Dr. Brohl expects that “clinicians and expert groups can use this risk-prediction model to inform practice guidelines and to provide more accurate and more individualized counseling to patients who require surgical intervention for uterine fibroids or myomas.“

In the retrospective analysis, the research team examined the Mount Sinai Data Warehouse (MSDW) database, which includes data on more than 3 million patients, to identify a cohort of 2,075 women who had undergone myomectomy for presumed benign leiomyoma between 2005 and 2014. Within this cohort, a total of 6 cases of unsuspected leiomyosarcoma or other uterine sarcomas were found at the time of surgery.

Next, the research team pooled the MSDW data with findings from 8 additional studies conducted between 1980 and 2014. In the total sample of 10,120 patients, 18 cases of leiomyosarcoma and 8 cases of other uterine sarcomas were identified at the time of surgery for presumed benign leiomyoma. The overall aggregate risk of unsuspected uterine sarcoma was 2.94 per 1,000 cases, or 1 in 340.

An analysis of age-stratified risk revealed that the risk of unsuspected uterine sarcoma varied significantly by age, with a more-than 5-fold difference between the highest- and lowest-risk groups. Women aged 75 to 79 years had the highest risk of unsuspected uterine sarcoma, at 10.1 cases per 1000 surgical procedures, or 1 in 98. By comparison, women aged

According to the study authors, the age-stratified risk-prediction model may have a role in supporting individual treatment decisions in the clinical practice setting. In addition, the risk-prediction model may play a role in shaping future surgical guidelines used in the management of leiomyoma.

Edwin Choy, MD, PhD, Director of Sarcoma Research at Massachusetts General Hospital and a member of The Oncologist’s editorial board, noted, “Dr. Brohl and his team reviewed over 10,000 cases of myomectomies in order to quantify unexpected cases of uterine sarcomas and stratify this risk by patient age. As a result of this research, patients can now be counseled with empirical data on their risks for undergoing a minimally invasive procedure. Additionally, hospitals, states, and medical organizations will be able to consider this data when setting policy or guidelines regarding the practice of morcellating tumors in the intraoperative setting."

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The full article, titled "Age-Stratified Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma,” can be accessed at http://theoncologist.alphamedpress.org/ .