Vascular Invasion and Survival in Extremity Leiomyosarcoma: An Exploratory Single-Center Cohort Study from the Oxford Sarcoma Service.
5 affiliations
- 1Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK.
- 2Oxford Sarcoma Service, Oxford University Hospitals, Oxford OX3 9DU, UK.
- 3Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
- 4Department of Orthopedics and Traumatology, Istanbul University, 34452 Istanbul, Turkey.
- 5Department of Cellular Pathology, Oxford University Hospitals, Oxford OX3 9DU, UK.
Abstract
Background/objectives
Extremity leiomyosarcoma is an uncommon soft tissue sarcoma with a more favorable prognosis than other anatomical subtypes. Risk stratification currently rests on tumor grade, size, and metastatic status. Vascular invasion is an established predictor of metastasis in mixed soft tissue sarcoma cohorts but has seldom been formally examined in extremity leiomyosarcoma. We assessed its prognostic value in a single-center cohort.Methods
We retrospectively studied 62 adults who underwent resection of primary localized extremity leiomyosarcoma at a tertiary sarcoma center between January 2015 and February 2025. Vascular invasion was reported contemporaneously at original diagnostic reporting by specialist sarcoma histopathologists. Overall (OS), disease-specific (DSS), local recurrence-free (LRFS), and metastasis-free (MFS) survival were estimated by the Kaplan-Meier method and compared using log-rank tests. Death from another cause was treated as a competing event for disease-specific death and distant metastasis in a sensitivity analysis. Multivariable Cox models were refitted using Firth's penalized likelihood, with discrimination corrected for optimism by bootstrapping.Results
Median follow-up was 59.5 months. Five-year OS, DSS, and MFS were 71.0%, 80.2%, and 74.6%. Vascular invasion was reported in 11 of 62 patients (17.7%) and was associated with inferior OS (p = 0.002), DSS (p < 0.001), and MFS (p < 0.001), but not LRFS (p = 0.631). Adjusted for grade, it was associated with inferior OS (HR 3.89, 95% CI 1.35-11.26), DSS (HR 5.48, 95% CI 1.46-20.58), and MFS (HR 5.63, 95% CI 1.69-18.80). The association persisted on separate adjustment for tumor size, depth, and neoadjuvant radiotherapy.Conclusions
Vascular invasion was associated with inferior survival in localized extremity leiomyosarcoma. With 17 deaths and 14 metastatic events, these are exploratory estimates, but they support documenting vascular invasion explicitly, as present or absent, in routine histopathological reporting so that its role can be evaluated at scale.
Related
- Clinical Heterogeneity and Survival Disparities in Leiomyosarcoma: An Exploratory Single-Center Retrospective Observational Study
- Investigating the potential association between the continuous-time random-walk MR diffusion model and lymph node metastasis and vascular invasion in patients with rectal cancer: A preliminary exploratory study
- Sex-associated differences in initial resection location, margin status, and re-excision in extremity leiomyosarcoma: a retrospective tertiary-center cohort study
- CO064 | THROMBOTIC AND BLEEDING EVENTS IN PATIENTS WITH VASCULAR INVASION BY ADVANCED HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW
- A pre-trained foundation model framework for multiplanar MRI classification of extramural vascular invasion and mesorectal fascia invasion in rectal cancer
BibTeX
@article{gill2026vascular,
title = {{Vascular Invasion and Survival in Extremity Leiomyosarcoma: An Exploratory Single-Center Cohort Study from the Oxford Sarcoma Service.}},
author = {Seva N S Gill and Tanjot S Kurala and Serkan Bayram and Jennifer M Brown and Muhammad Riaz and Muhammad A Siddiqi and Thomas D A Cosker},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18193212},
url = {https://europepmc.org/article/MED/42882907},
note = {CC BY},
}
RIS
TY - JOUR
TI - Vascular Invasion and Survival in Extremity Leiomyosarcoma: An Exploratory Single-Center Cohort Study from the Oxford Sarcoma Service.
AU - Seva N S Gill
AU - Tanjot S Kurala
AU - Serkan Bayram
AU - Jennifer M Brown
AU - Muhammad Riaz
AU - Muhammad A Siddiqi
AU - Thomas D A Cosker
PY - 2026
DA - 2026/10/05
JO - Cancers
DO - 10.3390/cancers18193212
UR - https://europepmc.org/article/MED/42882907
AB - Background/objectives Extremity leiomyosarcoma is an uncommon soft tissue sarcoma with a more favorable prognosis than other anatomical subtypes. Risk stratification currently rests on tumor grade, size, and metastatic status. Vascular invasion is an established predictor of metastasis in mixed soft tissue sarcoma cohorts but has seldom been formally examined in extremity leiomyosarcoma. We assessed its prognostic value in a single-center cohort.Methods We retrospectively studied 62 adults who underwent resection of primary localized extremity leiomyosarcoma at a tertiary sarcoma center between January 2015 and February 2025. Vascular invasion was reported contemporaneously at original diagnostic reporting by specialist sarcoma histopathologists. Overall (OS), disease-specific (DSS), local recurrence-free (LRFS), and metastasis-free (MFS) survival were estimated by the Kaplan-Meier method and compared using log-rank tests. Death from another cause was treated as a competing event for disease-specific death and distant metastasis in a sensitivity analysis. Multivariable Cox models were refitted using Firth's penalized likelihood, with discrimination corrected for optimism by bootstrapping.Results Median follow-up was 59.5 months. Five-year OS, DSS, and MFS were 71.0%, 80.2%, and 74.6%. Vascular invasion was reported in 11 of 62 patients (17.7%) and was associated with inferior OS (p = 0.002), DSS (p < 0.001), and MFS (p < 0.001), but not LRFS (p = 0.631). Adjusted for grade, it was associated with inferior OS (HR 3.89, 95% CI 1.35-11.26), DSS (HR 5.48, 95% CI 1.46-20.58), and MFS (HR 5.63, 95% CI 1.69-18.80). The association persisted on separate adjustment for tumor size, depth, and neoadjuvant radiotherapy.Conclusions Vascular invasion was associated with inferior survival in localized extremity leiomyosarcoma. With 17 deaths and 14 metastatic events, these are exploratory estimates, but they support documenting vascular invasion explicitly, as present or absent, in routine histopathological reporting so that its role can be evaluated at scale.
SN - 2072-6694
ER -