Outcome and prognostic factors of uterine sarcoma in 59 patients: single institutional results

Abstract

Purpose: Uterine corpus sarcomas are rare heterogeneous tumors characterized by rapid progression and poor response to treatment. This series investigated treatment options, relapse pattern, survival and prognostic factors.

Patients and methods: A total of 59 patients were treated in the National Cancer Institute, Cairo University, (2000-2007). Leiomyosarcoma accounted for 42.2% followed by carcinosarcoma (35.5%) and endometrial stromal sarcoma (18.6%). 40.7% had FIGO stage I disease, 30.5% were II, 16.9% were III and 11.9% were IV. Surgery was the primary line of treatment for all cases with total abdominal hysterectomy and bilateral salpingoophorectomy in 88% of cases and 12% had less extensive surgery. Twenty-four (40.7%) patients had surgery alone, 24 (40.7%) had surgery and radiotherapy, 7 (11.9%) had surgery and chemo-irradiation and 4 (6.7%) had surgery and chemotherapy.

Results: After 27.4 months mean follow-up (range: 2-69), relapses were detected in 32 patients (59.2%) including 19 (59%) systemic metastases. Stage, adjuvant irradiation, tumor size, myometrial invasion, vascular and cervix invasion were significant factors in univariate analysis; nevertheless, multivariate prognostic factors were only stage (p=0.04) and adjuvant irradiation (p=0.01). 5-year cumulative disease free survival for stage I was 63.6%, 41.2% for stage II, 10% for stage III and 0% in stage IV. Neither extent of surgery, chemotherapy, histologic type or grade had significant effect on survival. Adjuvant radiotherapy offered 62% 2-year cumulative overall survival versus 22% for surgery alone and surgery with chemotherapy. Salvage surgery for isolated relapses was performed for 9/32 recurrent patients (28%) including 5 lung metastatectomies and 4 local pelvic resections. Mean survival after pulmonary resections was 7.4 months (6-14).

Conclusion: Diagnosis of uterine sarcoma is in itself a poor prognostic factor. Complete cytoreductive surgery and adjuvant radiotherapy is essential for local control, provided tumor is limited to the uterus. Adjuvant irradiation showed survival benefit.

Key words: Uterine cancer - Uterine sarcoma - Uterine sarcoma treatment - Sarcoma irradiation - Sarcoma prognosis.