Preoperative clinical characteristics scoring system for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

Abstract Purpose: Preoperative diagnosis of uterine leiomyosarcoma (ULMS) is challenging because the disease can mimic benign leiomyoma (LM). The objective of the present study was to investigate the role of preoperative clinical characteristics and hematologic parameters in differentiating ULMS fromLM. Methods: Preoperative clinical and laboratory variables were retrospectively reviewed forpatients with ULMS or LM, and the significance of the intergroup differences was assessed. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoffvalues for each variable. Logistic regression analysis was applied to identify variables predicting the presence of ULMS. Results: The preoperative clinical and laboratory variables of 288 patients with uterine tumorswere analyzed. 64 patients had ULMS,and 224 had LM. A significant difference was observed between ULMS and LM. Multivariate analysis revealed that increased systemic immune-inflammation index (SII > 500), the controlling nutritional status score (CONUT≥3), larger tumor size (> 9.7 cm), and older age (>48 years) were independent risk factors for ULMS (P=0.007, <0.001, 0.001, <0.001,respectively). Thepreoperative clinical characteristic score was calculated by summing the number of risk factors with a total score of 4 points. A score≥ 2 points was a useful predictor for distinguishing ULMS from LM (sensitivity 0.688, specificity 0.888). Conclusion: Our results suggest that the SII, CONUT score, tumor size, age and preoperative Hb level could be useful for differentiating between ULMS and LM, which indicates that the preoperative clinical characteristics scoring system could be helpful in the preoperative diagnosis of indiscoverable ULMS.