Clinicopathological characteristics and prognosis of uterine sarcoma: a 10-year retrospective single-center study in China

Abstract

Background: Uterine sarcoma is a rare and heterogeneous gynecological malignancy characterized by aggressive progression and poor prognosis. The current study aimed to investigate the relationship between clinicopathological characteristics and the prognosis of uterine sarcoma in Chinese patients.

Methods: In this single-center retrospective study, we reviewed the medical records of 75 patients with histologically verified uterine sarcoma treated at the First Affiliated Hospital of Xi'an Jiaotong University between 2011 and 2020. Information on clinical characteristics, treatments, pathology and survival was collected. Progression-free survival (PFS) and overall survival (OS) were visualized in Kaplan-Meier curves. Prognostic factors were identified using the log-rank test for univariate analysis and Cox-proportional hazards regression models for multivariate analysis.

Results: The histopathological types included 36 endometrial stromal sarcomas (ESS,48%), 33 leiomyosarcomas (LMS,44%) and 6 adenosarcomas (8%). The mean age at diagnosis was 50.2 ± 10.7 years. Stage I and low-grade accounted for the majority. There were 26 recurrences and 25 deaths at the last follow-up. The mean PFS and OS were 89.41 (95% CI: 76.07-102.75) and 94.03 (95% CI: 81.67-106.38) months, respectively. Univariate analysis showed that > 50 years, post-menopause, advanced stage, ≥ 1/2 myometrial invasion, lymphovascular space invasion and high grade were associated with shorter survival (P < 0.05). Color Doppler flow imaging positive signals were associated with shorter PFS in the LMS group (P = 0.046). The ESS group had longer PFS than that of the LMS group (99.56 vs. 76.05 months, P = 0.043). The multivariate analysis showed that post-menopause and advanced stage were independent risk factors of both PFS and OS in the total cohort and LMS group. In the ESS group, diagnosis age > 50 years and high-grade were independent risk factors of PFS, while high-grade and lymphovascular space invasion were independent risk factors of OS.

Conclusion: In Chinese patients with uterine sarcoma, post-menopause and advanced stage were associated with a significantly poorer prognosis. The prognosis of ESS was better than that of LMS. Color Doppler flow imaging positive signals of the tumor helped to identify LMS, which needs to be further tested in a larger sample in the future.

Keywords: Chinese patients; Clinicopathological characteristics; Prognosis; Survival; Uterine sarcoma.

Fig. 1

Flow chart of the patient selection process

Fig. 2

Kaplan-Meier survival curves for progression-free survival (PFS) and overall survival (OS) stratified by clinical and pathological parameters in a-d: total cohort, e-h: endometrial stromal sarcoma (ESS) and i-k: leiomyosarcoma (LMS). a-b were stratified by menopausal status and FIGO stage for PFS in the total cohort; c-d were stratified by menopausal status and FIGO stage for OS in the total cohort; e-f were stratified by age at diagnosis and histological grade for PFS in the ESS group; g-h was stratified by histological grade and lymphovascular space invasion (LVSI) for OS in ESS group; i-j were stratified by menopausal status and FIGO stage for PFS in LMS group; k-l were stratified by menopausal status and FIGO stage for OS in LMS group