Clinical outcomes and prognostic factors in 55 patients with uterine sarcoma at a single institution

Objective: Uterine sarcomas are rare gynecological malignancies with poor prognosis. This study evaluated clinical outcomes and prognostic factors of patients with uterine sarcoma. Materials and Methods: A retrospective analysis was performed on 55 patients with uterine sarcoma, who had been treated and followed from 2004 to 2015 at Chonnam National University Hospital. Results: The median age of patients was 53 (range: 27-80) years, with 60.0% having postmenopausal status. Seventeen patients (30.9%) were diagnosed with endometrial stromal sarcoma (ESS), four (7.3%) with undifferentiated endometrial sarcoma (UES), three (5.4%) with leiomyosarcoma (LMS), and 31 (56.4%) with carcinosarcoma (CS). Surgery was the first line of treatment, including complete surgery for 54 patients and only myomectomy for one. FIGO Stage was I in 38 patients (69.1%), II in six (10.9%), III in seven (12.7%), and IV in four (7.3%). After a surgery, 37 patients (67.3%) received the adjuvant therapy, including 13 of chemotherapy, 11 of radiation, and 13 of chemoradiation. Complete and partial response presented in 78.2% and 1.8%, respectively. Progressive and stable disease presented in 16.4% and 3.6%, respectively. After a mean follow-up period of 43.5 (range: 1-136) months, relapses were detected in 20 patients (36.4%). The two- and five-year overall survival (OS) rates were 80.4% and 70.6%, respectively. The two- and five-year disease free survival (DFS) rates were 69.3% and 49.7%, respectively. Multivariate analysis revealed that menopause (p < 0.05), preoperative serum CA-125 elevation (p < 0.05), histological subtypes (p < 0.05), lymphovascular space invasion (LVSI) (p < 0.05), and LN involvement (p < 0.05) were associated with DFS, while no factor affected OS. Conclusions: In this study, the survival rates were higher than in many previous studies. The complete surgery and proper adjuvant therapies might lead to better outcomes. However, menopause, preoperative serum CA-125 elevation, more aggressive subtypes, LVSI, and LN involvement adversely affected prognosis.

Uterine sarcoma; Treatment; Outcome; Prognostic factor.

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