Impact of Surgery and Chemotherapy on Metastatic Extrauterine Leiomyosarcoma
, Satoshi Takenaka 2, Hidetatsu Outani 1, Takaaki Nakai 1, Naohiro Yasuda 1, Sho Nakai 2, Toru Wakamatsu 2, Hironari Tamiya 2 and Seiji Okada 1Round 1
Reviewer 1 Report
The Authors described clinicopathological characteristics and outcomes of 61 patients with metastatic euLMS. As the Authors highlight, this case series could be interesting for readers given the low incidence of these tumors as well as the heterogeneous behavior conditioned by site of tumor and metastases.
However, some points should be improved.
- The 14 years of recruitment is quite long and should be emphasized in the text discussion. Has something changed along this time? Surgical techniques? Increased rate of metastasectomy independently by the number of metastases?
- It should be interesting to differentiate the results into 2006-2013 and 2014-2020 and provide information on patients enrollment and outcomes according to the examined timeframe.
Author Response
The Authors described clinicopathological characteristics and outcomes of 61 patients with metastatic euLMS. As the Authors highlight, this case series could be interesting for readers given the low incidence of these tumors as well as the heterogeneous behavior conditioned by site of tumor and metastases.
However, some points should be improved.
- The 14 years of recruitment is quite long and should be emphasized in the text discussion. Has something changed along this time? Surgical techniques? Increased rate of metastasectomy independently by the number of metastases?
Surgical techniques have not changed much and the rates of metastasectomy have not increased along this study period. However, in Japan, pazopanib (since 2012), trabectedin (since 2015), and eribulin (since 2016) have been approved for the treatment of patients with any type of histology.
As the reviewer suggested, we added sentences as below.
During the study period, we could use pazopanib, trabectedin, and eribulin since 2012, 2015, and 2016, respectively.
- It should be interesting to differentiate the results into 2006-2013 and 2014-2020 and provide information on patients enrollment and outcomes according to the examined timeframe.
As shown in Table, there were more patients with metastatic euLMS arising from other sites such as abdomen and blood vessels diagnosed from 2014 to 2020 than those diagnosed from 2006 to 2013.
|
Factors |
　 |
2006-2013 (N=22) |
2014-2020 (N=39) |
p value |
|
Age |
≤60 |
15 |
19 |
0.184 |
|
>60 |
7 |
20 |
||
|
Sex |
Male |
7 |
18 |
0.296 |
|
Female |
15 |
21 |
||
|
Primary site |
Extremity |
8 |
14 |
0.00321 |
|
Trunk |
6 |
3 |
||
|
Retroperitoneum |
8 |
9 |
||
|
Others |
0 |
13 |
||
|
Size |
≤10cm |
13 |
24 |
1 |
|
>10cm |
9 |
15 |
||
|
Depth |
Superficial |
5 |
5 |
0.473 |
|
Deep |
17 |
34 |
||
|
Grade |
2 |
12 |
13 |
0.0937 |
|
3 |
8 |
25 |
||
|
N.A. |
2 |
1 |
- |
|
|
Presenting status |
Metachronous |
15 |
26 |
1 |
|
Synchronous |
7 |
13 |
||
|
Number of initial metastatic sites |
1 |
15 |
33 |
0.193 |
|
>1 |
7 |
6 |
||
|
Resection of primary tumor |
Yes |
20 |
33 |
0.699 |
|
No |
2 |
6 |
||
|
Metastasectomy with curative intent |
Yes |
9 |
15 |
1 |
|
No |
13 |
24 |
||
|
Chemotherapy |
Yes |
16 |
32 |
0.517 |
|
No |
6 |
7 |
||
|
Radiotherapy |
Yes |
11 |
13 |
0.276 |
|
　 |
No |
11 |
26 |
The median OS periods for patients with metastatic euLMS diagnosed from 2006 to 2013 and those diagnosed from 2014 to 2020 were 36.8 and 29.9 months, respectively. There was no significant difference between the two groups (p = 0.742).
As the reviewer indicated, we added sentences as below.
The median OS periods for patients with metastatic euLMS diagnosed from 2006 to 2013 and those diagnosed from 2014 to 2020 were 36.8 and 29.9 months, respectively. There was no significant difference between the two groups (p = 0.742).
Reviewer 2 Report
The authors examined the effect of surgery and chemotherapy on the prognosis of metastatic extrauterine leiomyosarcoma (LMS). This manuscript is well written and well organized. The results of this study are informative for the readers. My minor comments are listed below.
Since the study period is wide, the authors need to discuss the effect of the year of inspection on the treatments of LMS. The author also recommends to add this point as a limitation of this study.
Lines 237-258
This is a run-on paragraph and is excessively lengthy. Please divide this paragraph into two paragraphs.
Line 259
Please add the strength of this study.
Author Response
The authors examined the effect of surgery and chemotherapy on the prognosis of metastatic extrauterine leiomyosarcoma (LMS). This manuscript is well written and well organized. The results of this study are informative for the readers. My minor comments are listed below.
Since the study period is wide, the authors need to discuss the effect of the year of inspection on the treatments of LMS. The author also recommends to add this point as a limitation of this study.
Surgical techniques have not changed much and the rates of metastasectomy have not increased along this study period. However, in Japan, pazopanib (since 2012), trabectedin (since 2015), and eribulin (since 2016) have been approved for the treatment of patients with any type of histology.
As the reviewer suggested, we added sentences as below.
During the study period, we could use pazopanib, trabectedin, and eribulin since 2012, 2015, and 2016, respectively.
Lines 237-258
This is a run-on paragraph and is excessively lengthy. Please divide this paragraph into two paragraphs.
As the reviewer indicated, we provided this paragraph into two paragraphs.
Line 259
Please add the strength of this study.
As the reviewer suggested, we added sentences as below.
We believe that our study shows the efficacy of surgery and chemotherapy in patients with metastatic euLMS.
