Fertility-Sparing vs Hysterectomy for Uterine STUMP: A Pragmatic Clinical Study
Menée à partir de données multicentriques italiennes portant sur 401 patientes présentant des tumeurs musculaires lisses de l'utérus à potentiel malin incertain (âge moyen : 35,3 ans ; durée médiane de suivi : 51 mois), cette étude évalue l'efficacité, du point de vue de la survie sans récidive, et la sécurité d'une chirurgie préservant la fertilité (myomectomie ou résection hystéroscopique) par rapport à une chirurgie définitive (hystérectomie avec ou sans salpingo-ovariectomie)
Background: Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare neoplasms with unpredictable clinical behaviour. Optimal management, particularly in reproductive-aged women, remains controversial, with limited data comparing the safety of fertility-sparing versus hysterectomy.
Methods: This multicentre retrospective cohort study included women aged 18–85 with histologically confirmed STUMP treated at 17 Italian gynaecologic oncology centres from 2010 to 2023. Patients underwent either fertility-sparing surgery (myomectomy or hysteroscopic resection) or definitive surgery (hysterectomy ± salpingo-oophorectomy). Kaplan–Meier and Cox models were used to compare recurrence-free survival (RFS) and overall survival (OS).
Results: Median (range) follow-up was 51 (1-291) months. Among 401 women, 106 (26.4%) received fertility-sparing treatment (mean [± SD] age: 35.3 ± 6.8 years) and 295 (73.6%) underwent definitive surgery (mean [± SD] age: 47.7 ± 9.2). At total follow-up, recurrence occurred in 12.5% of patients, predominantly within the pelvis. Median RFS was longer after definitive surgery than after fertility-sparing procedures (50.0 vs 42.5 months; HR 2.39 [95% CI 1.36-4.19]), although this difference disappeared when benign (leiomyoma) recurrences were excluded (HR 1.74 [95% CI 0.90-3.34]). At last available follow-up, 97.5% of patients were alive, with no significant OS difference between treatment groups (HR 0.22 [95% CI 0.27-1.79]). Outcomes were comparable across menopausal status and concurrent adnexal removal.
Conclusion: Definitive surgery reduces recurrence risk, but long-term survival is similarly excellent after fertility-sparing surgery in appropriately selected women with STUMP. Conservative management represents a reasonable option for patients desiring fertility, provided they receive counseling regarding recurrence risk, diagnostic uncertainty, and the need for long-term surveillance.
European Journal of Cancer , résumé, 2026