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

Background: Uterine sarcoma is rare and heterogeneous gynecological malignancies characterized by aggressive progression and poor prognosis. The current study aimed to investigate the clinicopathological characteristics and 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 recorded. Results: : The histopathological types included 36 endometrial stromal sarcoma (ESS), 33 leiomyosarcoma (LMS), and 6 adenosarcoma. The mean age at diagnosis was 50.2±10.7 years. Stage I and low histologic grade accounted for the majority. There were 26 recurrences and 25 deaths at the last follow-up. The mean progression-free survival (PFS) and overall survival (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, ≥1/2myometrial invasion, lymphovascular space invasion, and high gradewere associated with shorter survival of uterine sarcoma ( P <0.05). Ultrasonic blood flow signals of the tumor were associated with shorter PFS in the LMS group ( P =0.046). The ESS group had longer PFS than 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 patients and in the LMS group. In the ESS group, diagnosis age >50 years and high histologic grade were independent risk factors of PFS, while high histologic grade and lymphovascular space invasion were independent risk factors of OS. Discussion: In Chinese patients with uterine sarcoma, post-menopause, and advanced stages are associated with a significantly poorer prognosis. The prognosis of ESS is better than LMS.