Preoperative diagnosis of uterine sarcoma is very difficult, and currently, its diagnostic accuracy is not satisfactory. It is therefore important to perform surgery and establish the pathological diagnosis if the clinical findings and various examination findings indicate possible uterine sarcoma. We investigated the accuracy of the combination of various types of predictors of uterine sarcoma and the novel PRE operative S arcoma S core (PRESS) for avoiding unnecessary surgery while diagnosing uterine sarcoma. We retrospectively analyzed the clinical findings, blood tests, imaging studies (ultrasonography and magnetic resonance imaging [MRI]), and endometrial cytology of 63 suspected uterine sarcoma cases that underwent surgery from 2006 to 2012. These cases were also scored retrospectively using PRESS. We analyzed the number of unnecessary surgeries that could be avoided using PRESS. Of 63 cases, 15 were diagnosed with uterine sarcoma (sarcoma group), and 48 had benign tumors (benign group). Univariate analysis indicated age, serum lactate dehydrogenase (LDH) values, and MRI and endometrial cytology findings as significant predictors of uterine sarcoma in both groups. In contrast, multivariable analysis identified only age, serum LDH value, and endometrial cytology findings as significant predictors. Accordingly, the latter were placed as 2 points, and the remaining MRI finding as 1 point. The accuracy rate of prediction was 84.1%, and the positive and negative predictive values were 63.2% and 93.2% respectively when the PRESS was interpreted as “positive” when it was 3 points or higher. Using multiple predictors for the preoperative diagnosis of uterine sarcoma, our proposed PRESS score is beneficial in the clinical setting while making treatment decisions in suspected uterine sarcoma cases as well as avoiding unnecessary surgery.

In 2014, we published an article titled “Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass” on the preoperative diagnosis of uterine sarcoma, in the SpringerPlus (Nagai et al. in SpringerPlus 2014, 3:678. doi: 10.1186/2193-1801-3-678 ). Subsequently, we received several suggestions from readers, which were used to modify the statistical analysis methods and create a more precise preoperative diagnostic scoring system, which we present here as a supplemental report. The subjects were 63 patients who underwent surgical therapy for suspected uterine sarcoma (sarcoma group: 15 patients, benign group: 48 patients). Logistic regression analysis using the exact method was performed considering the subjects’ preoperative age, serum lactate dehydrogenase levels, magnetic resonance imaging findings, and endometrial cytology findings. We then used parameter estimates obtained from this analysis to revise the PREoperative Sarcoma Score (PRESS). The revised PRESS (rPRESS) has a maximum score of 10 points and an optimal cut-off value of 4 points, as derived from a receiver operating characteristic curve. Using this, the accuracy, positive predictive value, and negative predictive value were 93.7, 92.3, and 94.0 %, respectively. The diagnostic precision of the rPRESS is better than that of the original PRESS.

The Proactive Molecular Risk Classifier for Endometrial Cancer has identified four risk groups for the prognosis of endometrial cancer. Lenvatinib plus pembrolizumab was recently approved as a second-line treatment for unresectable endometrial cancer, but reports in clinical practice are lacking. The relationship between the efficacy of lenvatinib/pembrolizumab and Proactive Molecular Risk Classifier for Endometrial Cancer classification is unclear. This single-centre retrospective study included patients who underwent lenvatinib/pembrolizumab therapy at Iwate Medical University Hospital between January 2022 and March 2023. Formalin-fixed paraffin-embedded specimens obtained from patients before treatment were collected and classified into the mismatch repair-deficient, p53 abnormal and no specific molecular profile subtypes using immunohistochemistry. The response rate, progression-free survival and adverse events were evaluated using electronic medical records. The study was approved by the hospital’s ethics committee (approval number: MH2022-093). This study enrolled 20 patients, who underwent a median follow-up of 17.8 months (95% confidence interval: 16.6–18.9). The best overall response rate was 60.0% (36.1–80.9), and the median progression-free survival was 11.6 months (2.9–20.3). The median progression-free survival in the p53 abnormal group (n = 9) was 3.4 months (3.0–3.8); however, progression-free survival did not reach the median (P < 0.001) in the mismatch repair-deficient/no specific molecular profile group (n = 11). Symptomatic immune-related adverse events (except hypothyroidism) occurred in 4/20 (25.0%) patients, and partial responses were observed in all cases. No treatment-related deaths occurred. The p53abn group in the Proactive Molecular Risk Classifier for Endometrial Cancer classification has a poor prognosis even after treatment with lenvatinib/pembrolizumab.