Risk of Recurrence in Uterine Leiomyoma with Bizarre Nuclei: a Systematic Review and Meta-Analysis

Abstract

Objective Leiomyoma with bizarre nuclei (LBN) is a variant of uterine leiomyoma, which has replaced the previous category of “atypical leiomyoma” and must be distinguished from smooth muscle tumors of uncertain malignant potential (STUMP). However, previously published series of “atypical leiomyoma” might have included both LBN and STUMP, due to the lack of strict diagnostic criteria. Based on such hypothesis, we aimed to define the risk of recurrence in LBN.

Study Design A systematic review and meta-analysis was performed by searching 4 electronic databases for all studies assessing the outcome of patients with “atypical leiomyoma” or LBN. The pooled absolute risk of recurrence was calculated. The included studies were subdivided into two subgroups based on the criteria used: “LBN + STUMP” or “LBN-only”.

Results Twelve studies with 433 patients were included. The pooled risk of recurrence was 5.5% overall. The funnel plot showed two cluster of studies which superimposed to the two subgroups. In the LBN + STUMP cluster/subgroup, the pooled risk of recurrence was 7.7%. In the LBN-only cluster/subgroup, the pooled risk of recurrence was 1.9%. Statistical heterogeneity was null in all analyses.

Conclusion Our results show a risk of recurrence of 1.9% for LBN; higher recurrence rates in older studies are likely due to the inclusion of STUMPs.

Zusammenfassung

Zielsetzung Leiomyom mit bizarrem Zellkern (LBN) ist eine Variante von uterinen Leiomyomen, welche die frühere Kategorie „atypisches Leiomyom“ ersetzt; sie sollte von glattmuskulären Tumoren mit unsicherem malignen Potenzial (STUMP) unterschieden werden. Weil aber strenge diagnostischen Kritierien bei früheren Studien fehlten, kann es sein, dass früher veröffentlichte Serien von atypischen Leiomyomen sowohl LBN als auch STUMP umfassen. Basierend auf dieser Hypothese war das Ziel unserer Studie, die Gefahr eines Rezidivs bei LBN zu definieren.

Studiendesign Eine systematische Überprüfung und eine Metaanalyse wurden durchgeführt. Hierzu wurden 4 elektronische Datenbanken nach Studien durchsucht, die das Outcome von Patientinnen mit atypischen Leiomyomen bzw. LBN evaluierten. Das gepoolte absolute Risiko eines Rezidivs wurde berechnet. Die eingeschlossenen Studien wurden in 2 Untergruppen unterteilt: eine LBN + STUMP-Gruppe und eine Nur-LBN-Gruppe.

Ergebnisse Zwölf Studien mit insgesamt 433 Patientinnen wurden gefunden und evaluiert. Das gepoolte Risiko eines Rezidivs betrug insgesamt 5,5%. Der Funnel Plot zeigte 2 Cluster von Studien, die sich mit den 2 Untergruppen überlagerten. In der LBN + STUMP-Cluster/Untergruppe betrug das gepoolte Risiko für ein Rezidiv 7,7%. In der Nur-LBN-Cluster/Untergruppe betrug das gepoolte Risiko eines Rezidivs dagegen 1,9%. Die statistische Heterogenität betrug bei allen Analysen null.

Schlussfolgerung Unsere Ergebnisse zeigen, dass die Gefahr eines Rezidivs bei LBN 1,9% beträgt; die höheren Rezidivraten in älteren Studien beruhen wahrscheinlich auf dem Einschluss von STUMP.

Key words

prognosis - diagnosis - sarcoma - myoma - leiomyoma - myomata

Schlüsselwörter

Prognose - Diagnose - Sarkom - Myom - Leiomyom - Myome

Publication History

Received: 26 March 2021

Accepted: 18 June 2021

Article published online:
04 November 2021

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