Metastatic Pattern of Truncal and Extremity Leiomyosarcoma: Retrospective Analysis of Predictors, Outcomes, and Detection

Leiomyosarcomas (LMS) are a heterogenous group of malignant mesenchymal neoplasms with smooth muscle origin and are classified as either non-uterine (NULMS) or uterine (ULMS). Metastatic pattern, prognostic factors, and ideal staging/surveillance studies for truncal and extremity LMS have not been defined. A retrospective analysis of patients diagnosed with histopathology-confirmed truncal or extremity LMS between 2009 and 2019 was conducted. Data collected included demographics, tumor characteristics, staging, surveillance, and survival endpoints. The primary site was defined as: (1) extremity, (2) flank/Pelvis, or (3) chest wall/Spine. We identified 73 patients, 23.3% of which had metastatic LMS at primary diagnosis, while 68.5% developed metastatic disease at any point. The mean metastatic-free survival from primary diagnosis of localized LMS was 3.0 ± 2.8 years. Analysis of prognostic factors revealed that greater age (≥50 years) at initial diagnosis (OR = 3.74, p = 0.0003), higher tumor differentiation scores (OR = 12.09, p = 0.002), and higher tumor necrosis scores (OR = 3.65, p = 0.026) were significantly associated with metastases. Older patients (≥50 years, OR = 4.76, p = 0.017), patients with larger tumors (≥5 cm or ≥10 cm, OR = 2.12, p = 0.02, OR = 1.92, p = 0.029, respectively), higher differentiation scores (OR = 15.92, p = 0.013), and higher necrosis scores (OR = 4.68, p = 0.044) show worse survival outcomes. Analysis of imaging modality during initial staging and during surveillance showed greater tumor detection frequency when PET imaging was employed, compared to CT imaging (p < 0.0001). In conclusion, truncal and peripheral extremity LMS is an aggressive tumor with high metastatic potential and mortality. While there is a significant risk of metastases to lungs, extra-pulmonary tumors are relatively frequent, and broad surveillance may be warranted

Example calculations.

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Disability-adjusted life years averted through pediatric cancer treatment at Bugando Medical Centre from January 2010 to August 2014.

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Five-year survival rates at Bugando Medical Centre for children beginning treatment from January 2010 to August 2014.

Five-year survival rates at Bugando Medical Centre for children beginning treatment from January 2010 to August 2014.</p

Total costs of pediatric cancer treatment for 161 children at Bugando Medical Centre from January 2010 to August 2014.

Total costs of pediatric cancer treatment for 161 children at Bugando Medical Centre from January 2010 to August 2014.</p

Total economic benefit of cancer treatment of 161 children at Bugando Medical Centre from January 2010 to August 2014.

Total economic benefit of cancer treatment of 161 children at Bugando Medical Centre from January 2010 to August 2014.</p

Table 2 - Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania

Table 2 - Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania</p

Disability-adjusted life years averted through cancer treatment of 161 children at Bugando Medical Centre from January 2010 to August 2014.

Disability-adjusted life years averted through cancer treatment of 161 children at Bugando Medical Centre from January 2010 to August 2014.</p

Total economic benefit of cancer treatment of 161 children at Bugando Medical Centre from January 2010 to August 2014.

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Economic impact per patient using human capital approach.

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