Outcomes after resection of leiomyosarcomas of the inferior vena cava: A pooled data analysis of 377 cases. (March 2015)

• Record Type: Journal Article
• Authors: Wachtel, Heather; Gupta, Meera; Bartlett, Edmund K.; Jackson, Benjamin M.; Kelz, Rachel R.; Karakousis, Giorgos C.; Fraker, Douglas L.; Roses, Robert E.
• Is Part Of: Surgical oncology. Volume 24:Number 1(2015)
• Page Start: 21
• Page End: 27
• Publication Date: 2015-03
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2014.10.007
• Languages: English
• ISSNs: 0960-7404

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Primary leiomyosarcomas of the inferior vena cava (IVC) pose unique surgical challenges. Due to the rarity of the disease, little definitive data exists on prognosis and treatment options.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">A pooled data analysis was performed on all cases of initial IVC leiomyosarcoma resection identified by literature search (<italic>n</italic> = 371) and our institutional database (<italic>n</italic> = 6). Kaplan–Meier and Cox regression analyses were performed to identify factors associated with disease-free survival (DFS) and overall survival (OS).</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">Patients were predominantly female (76%, <italic>n</italic> = 286); the median age of presentation was 55 years. Five-year DFS and OS were 6% and 55%, respectively. Preoperative factors independently associated with decreased OS included older age (HR:1.05, 95% CI:1.00–1.09), larger tumor size (HR:1.14, 95% CI:1.04–1.24), resection of adjacent organ(s) (HR:3.62, 95% CI:1.34–9.77), and R2 resection (HR:7.80, 95% CI:1.94–32.05). Isolated involvement of the suprarenal infrahepatic IVC was associated with longer OS (HR:0.22, 95% CI:0.06–0.78). A scoring system incorporating independent predictors of OS stratified outcomes: score 4–5 (<italic>n</italic> = 10, median OS 6 months), score 2–3 (<italic>n</italic> = 88, median OS 23 months) compared to a score of 0–1 (<italic>n</italic> = 44, median OS 29 months).</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">Following resection of IVC leiomyosarcomas, recurrence is a near certainty; long-term survival, however is possible. The dominant predictors of survival include margin status, tumor size and radical resection. These can be combined into a risk score that has prognostic value.</p> </sec> </abstract>