Prognostic factors, survival outcomes, and surgical practices when dealing with uterine sarcomas: 8 years’ clinical experience

Abstract

Objective:To determine the clinical and pathologic characteristics, prognostic factors, surgical practice, adjuvant therapies, and survival outcomes of patients with uterine sarcoma diagnosed and treated in our institution.Material and Methods:Patients diagnosed and treated for uterine sarcomas at our institution from 2009 to 2017 were retrospectively evaluated. All histologic slides from the specimens underwent a thorough pathologic review by a gynecologic pathologist. The following variables were assessed: age, family history of cancer, smoking status, age of menarche, parity, age at first delivery, related symptoms, clinical staging, histologic type, treatment received, disease-free period, and the time and site of recurrence, as well as treatment of the latter and overall survival.Results:Ten patients were diagnosed as having leiomyosarcoma, a further 10 patients had malignant mixed mullerian tumors, and five had endometrial stromal sarcoma; the remaining nine patients had other tumors. At the end of our study, 12 (35.3%) patients were alive and in remission, four (11.8%) were alive with disease, 10 (29.4%) were lost to follow-up, and eight (23.5%) had died. The mean survival time was 80.92 months, and the 2-year survival rate was 75.6%. We found that survival was significantly shorter in the presence of lymph node involvement, residual tumor, and recurrence.Conclusion:This study serves to inform physicians about the outcome of various uterine sarcomas that were diagnosed and managed at our center. We found that 35.3% of our patients were alive and in remission, 11.8% were alive with disease, 29.4% were lost to follow-up, and 23.5% of patients died.

Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years’ clinical experience from a tertiary care center in Pakistan

“…This is also consistent with the published literature in which u-LMS was the most frequent subtype of uterine sarcoma [ 2 , 23 ]. The median age in our study group was 49 (40–55.5 years), which is also similar to the previously published studies [ 23 – 25 ]. Previous studies on uterine sarcomas have included carcinosarcoma patients; in some, an almost equal number of carcinosarcoma and u-LMS patients were included in their analysis [ 23 – 26 ].…”

“…In contrast, our study did not include carcinosarcoma patients due to their epithelial origin and because they are no longer considered in the uterine sarcoma group [ 3 ]. This has provided a more relevant analysis of disease characteristics and outcomes knowing of the changes in the classification [ 23 – 25 ].…”

“…The data for PLND, in addition to TAH and BSO, is still evolving. The literature varies and may range from 30 to 74% [ 25 , 27 ]. However, no significant survival benefits of PLND have been reported [ 25 ].…”

Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma

“…Several prognostic factors have been recognized from retrospective data to guide therapeutic decisions for uterine sarcoma patients. Patients with old age, advanced stage, high tumor grade, and high mitotic index have been found to have worse prognosis [ 13 , 14 , 15 , 16 ]. However, diagnosis and treatment of uterine sarcoma remain unclear.…”

“…Even with stage I, 11 of 15 patients who relapsed had a high NLR. Previous studies have also reported that high proportions (66.4% and 71.9%) of patients with uterine sarcoma have stage I [ 12 , 15 ]. Treatment options (observation or systemic therapy) for stage I uterine sarcoma including LMS and high grade ESS after surgical resection are controversial and vague according to National Comprehensive Cancer Network (NCCN) guidelines.…”