Background: Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma originating from smooth muscle or its mesenchymal precursor cells, accounting for approximately 10%-20% of all soft tissue sarcomas.Radiotherapy can improve local control and reduce recurrence, but its benefit on overall survival remains unclear.Chemotherapy and radiotherapy are typically used as adjuvant or combined treatment strategies.This study aims to identify prognostic factors for LMS and evaluate the efficacy of different treatment approaches to improve clinical management and provide guidance for future research.Methods: This study retrospectively analyzed the clinical, pathological, treatment, and survival data of LMS patients treated at Zhejiang Cancer Hospital from 2000 to 2024.Results: A total of 336 LMS patients were included in this study.The 5-year progression-free survival (PFS) and overall survival (OS) rates were 18.8% and 61.6%, respectively, with a median PFS of 17.5 months and a median OS of 94.3 months.Advanced age (50 years), grade 3 tumors, and stage IV disease were identified as significant risk factors for poor prognosis.In stage I uterine LMS patients, oophorectomy, retroperitoneal lymph node dissection, and adjuvant chemotherapy did not show a significant impact on survival.For metastatic LMS patients, gemcitabine combined with docetaxel showed better efficacy compared to single-agent anthracycline therapy, although the difference was not statistically significant.The efficacy of gemcitabine combined with docetaxel was similar to that of anthracycline-based regimens, while anthracycline plus dacarbazine showed the highest response rate and a better survival trend among anthracycline therapies.Conclusions: Advanced age (50 years), grade 3 tumors, and late-stage disease are risk factors for poor survival outcomes.For stage I uterine LMS patients, oophorectomy, lymph node dissection, and adjuvant chemotherapy do not affect survival.For advanced-stage patients, gemcitabine combined with docetaxel or anthracycline plus dacarbazine as first-line chemotherapy may be preferred.
Qi et al. (Sun,) studied this question.