Prognostic factors and survival of patients with uterine sarcoma: a German unicenter analysis

Abstract

Purpose Uterine sarcoma (US) as a histologically heterogeneous group of tumors is rare and associated with poor prognosis. Prognostic factors based on systematic data collection need to be identified to optimize patients’ treatment. Methods This unicenter, retrospective cohort study includes 57 patients treated at the University Hospital Freiburg, Germany between 1999 and 2017. Progression-free survival (PFS) and overall survival (OS) were calculated and visualized in Kaplan–Meier curves. Prognostic factors were identified using log-rank test and Cox regression. Results 44 Leiomyosarcoma (LMS), 7 low-grade endometrial stromal sarcoma (LG-ESS), 4 high-grade ESS and 2 undifferentiated US patients were identified. The median age at time of diagnosis was 51.0 years (range 18–83). The median follow-up time was 35 months. PFS for the total cohort was 14.0 (95%-Confidence-Interval (CI) 9.7–18.3) and OS 36.0 months (95%-CI 22.1–49.9). Tumor pathology was prognostically significant for OS with LG-ESS being the most favorable (mean OS 150.3 months). In the multivariate analysis, patients over 52 years showed a four times higher risk for tumor recurrence (hazard ratio (HR) 4.4; 95%-CI 1.5–12.9). Progesterone receptor negativity was associated with a two times higher risk for death (HR 2.8; 95%-CI 1.0–7.5). For LMS patients age ≥ 52 years (p = 0.04), clear surgical margins (p = 0.01), FIGO stage (p = 0.01) and no application of chemotherapy (p = 0.02) were statistically significant factors for OS. Conclusion Tumor histology, age at time of diagnosis and progesterone receptor status were prognostic factors for US. Unfavorable OS in LMS patients was associated with advanced FIGO stage, suboptimal cytoreduction and application of chemotherapy.

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

“…Some studies reported that regimens of ifosfamide [11,35,36] or doxorubicin [11,32,36] were effective for uterine sarcoma and decreased the risk of metastasis. Some researchers found that adjuvant chemotherapy was associated with decreased survival [12,37], while others showed better pelvic control and survival rate in adjuvant chemotherapy than those who did not receive either adjuvant chemotherapy or radiotherapy after TH-BSO [11,14,33]. In our study, 76.7% of patients received chemotherapy or chemoradiotherapy after surgery, yet adjuvant therapy didn't affect their survival, which was similar to previous studies [38][39][40].…”

“…Preoperative diagnosis is usually di cult due to the lack of speci c symptoms and diagnostic techniques [1]. So far, most researches on the relationship between risk factors, adjuvant treatment and survival were conducted in western countries [12][13][14][15][16], but much less is known about such association in China [17]. Our retrospective study provided insights into the clinicopathological features and prognosis factors of 75 Chinese uterine sarcoma patients over 10 years.…”

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

“…Regarding sarcoma prognosis, tumor injury during excision and uncontained morcellation, electric or manual, in both laparotomy and laparoscopy [30][31][32], plays a critical role in upgrading metastasis, resulting in poorer prognosis [33][34][35][36][37]. Hence, several prognostic factors for all histological uterine sarcoma types have been identified, including patient age, tumor stage, mitotic index, vascular invasion, and tumor-free resection margins.…”

Prognostic analysis of different pathological types of uterine sarcoma

“…Overall, the evidence suggests that PR receptor negativity is a negative prognostic factor in leiomyosarcoma. Patients with PR-negative tumors are more likely to have a shorter survival time than patients with PR-positive tumors (23,24).…”