Epidemiology of adenosarcoma and the inverse probability of treatment weighting (IPTW) adjusted survival analysis of lymph node dissection in uterine adenosarcoma

Abstract

The objective for the study was to analysis the epidemiology of adenosarcoma, and independent prognostic factors and impact of lymph node dissection (LND) of uterine adenosarcoma. Cases of patients with primary adenosarcoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2016. Overall survival was analyzed by the Kaplan-Meier method and log-rank test. The differences in baseline covariates between the 2 groups were adjusted by inverse probability of treatment weighting method. The prognostic factors were identified by univariate and multivariate Cox regression analysis and hazard ratio and 95% confidence interval (CI) of covariates were also estimated. 1129 patients with pathological primary adenosarcoma between 2000 and 2016 were identified from the surveillance, epidemiology, and end results database. The only 4 patients were male. 1027 patients with primary uterine adenosarcoma, and 53.1% underwent LND and only 3.5% patients were with positive lymph node. Age, marital status, largest tumor size, tumor grade, T stage and chemotherapy were significantly correlated with survival. Race, tumor number, LND, and radiotherapy did not affect overall survival in patients. Inverse probability of treatment weighting-adjusted K-M curve showed that LND did not improve survival and lymph node metastasis (LNM) did not affect survival. The majority of primary adenosarcoma patients are female with high incidence of uterus and rare incidence of distant metastasis. Age, marital status, tumor size, T stage, grade, and chemotherapy are independent prognostic factors of uterine adenosarcoma. LNM was not a significant prognostic risk factor, and LND did not benefit survival.

Uterine Adenosarcoma: An Unpredictable Enemy

“…Surgical treatment (hysterectomy and bilateral salpingo-oophorectomy) represents the standard treatment for UA and it should be performed by an expert gynecologist oncologist in referral centres. Due to the low risk of regional lymph nodes metastasis, lymphadenectomy is not recommended [11] Currently there is no standardized specific radiation therapy, hormonal therapy or adjuvant chemotherapy for the treatment of UA. Adjuvant radiotherapy can be offered to low risk patient without sarcomatous overgrowth and less of 50% myometrial invasion [2][3][4][5][6][7][8][9][10][11][12].…”

“…Due to the low risk of regional lymph nodes metastasis, lymphadenectomy is not recommended [11] Currently there is no standardized specific radiation therapy, hormonal therapy or adjuvant chemotherapy for the treatment of UA. Adjuvant radiotherapy can be offered to low risk patient without sarcomatous overgrowth and less of 50% myometrial invasion [2][3][4][5][6][7][8][9][10][11][12]. Immunohistochemical markers commonly expressed by adenosarcoma are CD10 (71 to 100%) and WT1 (79%) while additional markers are smooth muscle actin (50 to 68%), CD34 (35%), desmin (32 to 62.5%), AE2/3 cytokeratin (25 to 27%) and vimentin (86%).…”

Next-Generation Sequencing Analysis of 3 Uterine Adenosarcomas with Heterogeneously Differentiated Genomic Mutations

“…The high-risk factors might affect the prognosis of adenosarcoma [ 24 ] and therefore individualized treatment should be considered. In terms of adjuvant therapy, it has been shown that adenosarcoma recurrence with or without sarcoma overgrowth responds to the treatment regimen of ifosfamide or doxorubicin [ 25 ]. However, radiotherapy does not benefit the overall survival of patients, and there is insufficient evidence regarding the benefits of chemotherapy and hormone therapy [ 25 ].…”

“…In terms of adjuvant therapy, it has been shown that adenosarcoma recurrence with or without sarcoma overgrowth responds to the treatment regimen of ifosfamide or doxorubicin [ 25 ]. However, radiotherapy does not benefit the overall survival of patients, and there is insufficient evidence regarding the benefits of chemotherapy and hormone therapy [ 25 ]. Further studies are needed to determine the most effective adjuvant therapy.…”