Old versus new FIGO staging systems in predicting overall survival in patients with uterine leiomyosarcoma: A study of 86 cases

ObjectivesUterine leiomyosarcoma (uLMS) was staged using the FIGO system for endometrial cancers. The new FIGO system takes into consideration tumor size disregarding myometrial and cervical involvement. We aimed to compare the two systems and see which more accurately predicts overall survival (OS).Methods86 patients with uLMS (1984–2010) were retrospectively staged using both FIGO systems. Mean OS rates were estimated using the Kaplan–Meier method.ResultsMore patients had stage-I disease by the new FIGO system (42 versus 33). Five versus 18 and 27 versus 5 had old and new stage-II and III diseases respectively. Five and 4 patients with old stage II and III uLMS respectively were downstaged to stage I while 18 with old stage III were downstaged to stage II. Median follow-up was 23.5 months with a median OS of 114 (95% CI, 61–166) months. Although patients with stage I tumors had a higher mean OS rate compared to those with higher stage disease by either system, patients with old stage II–IV disease showed similar mean OS rates, with stage III–IV patients having a slightly better mean OS and a similar trend was observed with the new system. Patients with new FIGO stage III had a higher mean OS rate than those with stage II or IV disease (37.6 versus 28.1 and 34.3 months). Nonetheless, no statistical significant differences were seen in OS according to stage using either system (p = 0.786 and p = 0.400 respectively).ConclusionNeither FIGO staging system is ideal in classifying patients into four clinically significant stages.

► A new FIGO staging system has been adopted for uterine sarcomas, including leiomyosarcomas.
► We compared the merits of the old and new FIGO staging systems in predicting overall survival in patients with uterine leiomyosarcoma.
► Neither the old nor new FIGO staging system is ideal in classifying patients into four clinically significant stages predictive of survival.