Retrospective analysis of 105 cases of uterine sarcoma

Abstract

16079 Background: Currently there is no randomized study based or widely accepted therapeutic modality in uterine sarcomas which are rare tumors forming a heterogeneous group in respect to their pathologic classification. Methods: In our trial, 105 pts. with uterine sarcoma who were referred to our clinic between years 1995–2003 have been retrospectively researched to evaluate the results in this tumor group. 43.8% had Leiomyosarcoma (LMS), 28.6% had Endometrial Stromal Sarcoma (ESS) and 27.6% had a Malign Mullarian Mixed Tumor (MMMT) while the distribution according to the histological subgroups were found to be 58.8% and 41.2% in low + middle grade tumors combined and in high grade tumors respectively. 76.2% had a Total Abdominal Hysterectomy + Bilateral Salphingooverectomy (TAH+BSO), 18.1% had a Total Abdominal Hysterectomy + Bilateral Salphingooverectomy + Lymphadenectomy (TAH+BSO+LND) and 5.7% had a suboptimal surgery as a surgical procedure. 38.1% of the pts. had Radiotherapy (RT), 18.1% had Chemotherapy (CT) and 12.4% had Chemo-radiotherapy (CT+RT) in addition to surgery. Results: The median age of the whole group is 51 (24–87). 55% of our pts. are under 50 years old and 68.5% had an “organ limited disease” ( stages I-II combined). The distant metastases rate is 30% and the local recurrence is 16.2%. All the local recurrences and 90% of the distant metastases have occurred within the first two years. The disease free survival rates at 3 and 5 years are 54.46% and 49.88% ; while the overall survival rates at 3 and 5 years are 54.63% and 51.09% all respectively. The stage is the most important factor effecting on the O.S and 5- year O.S rate is 68.43% in Stage I disease. Conclusions: The aggressive tumor progression pattern and the poor prognosis of uterine sarcomas require adjuvant therapies. The merit of current therapeutic options are still on debate since none of them has proved any specific effects. Planning further multi-center retrospective studies with high number of pts., a more clear description of the prognostic factors and thus the determination of the most appropriate therapeutic option is definitely needed. No significant financial relationships to disclose.

Treatment of uterine sarcomas at the Maribor University Clinical Centre between 1996 and 2011

“…We counted 22 cases in 16 years, which is 3.3% of the 661 uterine cancers treated at our institution during this time period. The age range of our patients was wide and presented similar distribution characteristics, as described in other studies (6,(13)(14)(15). The same is true for the distribution of different histologic subtypes, with leiomyosarcomas being the most common, followed by carcinosarcomas and a smaller number of endometrial stromal sarcomas.…”

“…Only 19% of our patients received post-operative chemotherapy. Chemotherapy was comparatively rare in similar studies as well, although it was somewhat more frequent in patients with higher disease stages (6,13,18). Although some authors have stated no influence of adjuvant chemotherapy on survival of patients with uterine sarcomas (14,18), others have declared an increase of recurrence-free survival in those who received adjuvant chemotherapy (7).…”

“…Our 1-year OS rate was 60% and the 5-year OS rate was 44%. The 5-year survival rates in similar studies which considered all histologic subtypes of sarcomas were between 36% and 60% (6,13,39). OS is clearly influenced by disease stage at the time of diagnosis (1,6,13,18).…”

“…The 5-year survival rates in similar studies which considered all histologic subtypes of sarcomas were between 36% and 60% (6,13,39). OS is clearly influenced by disease stage at the time of diagnosis (1,6,13,18). The OS of the treated patients in our study was good compared to other studies.…”

Prognostic indicators in WHO 2003 low‐grade endometrial stromal sarcoma

“…Prognostic studies on ESS‐LG after 2003 are rare; Table 1 summarizes articles since 2003 with potential prognostic information. Some of these studies included various types of uterine sarcoma but, unfortunately, the breakdown of results into histological subtypes was either not provided or endometrial stromal sarcomas accounted for a small minority of cases and were not separately discussed 5‐12 . In others, the old classification of low‐grade and high‐grade endometrial stromal sarcomas was still used 13‐22 …”