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

الملخص EN

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, (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, myometrium 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 41.2 %, 63.6 % 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 5recurrent patients (28 %) including 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.