Factors Associated With Recurrence After Surgical Resection in Women With Intravenous Leiomyomatosis.

OBJECTIVE

To analyze the recurrence features and prognostic factors of patients with intravenous leiomyomatosis after complete tumor resection.

METHODS

We conducted a retrospective study of 58 patients with intravenous leiomyomatosis with follow-up data out of 75 patients treated from September 2005 to September 2015 and an analysis of postoperative recurrence features and prognostic factors.

RESULTS

The average patient age was 45.4 years. The preoperative diagnosis rate was low. Among the 58 total patients, 31 had tumors that spread to the inferior vena cava and heart. During the median follow-up of 11.5 months, recurrence occurred in 18 patients at a rate of 31.0% (95% confidence interval 19.0-43.0%). Recurrence was associated with the preoperative tumor extent, and large vein involvement (16/31 compared with 2/27, P=.02) was a risk factor for postoperative recurrence. Postoperative recurrence was not associated with age (1/10 in 50 years or older compared with 17/48 younger than 50 years, P=.35), involvement of the heart (10/22 compared with 8/36, P=.28), resection of the uterus (16/51 compared with 2/7, P=.84) or bilateral ovaries (15/40 compared with 3/18, P=.65) with complete tumor removal, the choice of one-stage or two-stage surgery (11/45 for one-stage surgery compared with 7/13 for two-stage surgery, P=.20), postoperative antiestrogen hormone therapy (10/24 compared with 8/34, P=.53), or the hormone therapy duration (5/17 in the over-6-months group compared with 13/41 in the under-6-months group, P=.81).

CONCLUSION

The postoperative recurrence rate of intravenous leiomyomatosis was high, and large vein involvement was associated with an increased risk of recurrence. Continued postoperative follow-up is important. Neither resection of bilateral ovaries nor postoperative hormone therapy was associated with recurrence.