Uterine Sarcoma: Analysis of Prognostic variables in 40 cases

Choi, Jong Yeol; Kim, Hyoung Jung; Eo, Wan Kyu; Kim, Heung Yeol

Abstract

OBJECTIVE
Uterine sarcomas are rare tumors of mesodermal origin and constitute 2-6% of uterine malignancies. They are the most malignant group of uterine tumors and present difficult problems with regard to diagnosis and treatment. The aim of this study is to investigate the clinicopathologic finding and outcome of patients with uterine sarcoma.
METHODS
From Jan. 1996 to Dec. 2004, 40 patients with histologically proven uterine sarcomas at Gospel Hospital were evaluated for their clinical profile and survival retrospectively.
RESULTS
The age of patients with uterine sarcoma ranged 28 to 71 years, and the mean age was 48.0 years. The common presenting symptoms were abnormal uterine bleeding, abdominal pain and lower abdominal palpable mass. The overall 5-year survival rate of uterine sarcoma was 48.9% and the mean survival time was 73.6 months. The overall 5-year survival rate of 24 patients less than 50 years was significantly better than that of 16 patients more than 50 years, 69.1% vs 24.6% (P=0.0139). When classified according to histologic type, there were 21 cases (52.5%) of leiomyosarcoma (LMS), 8 cases (20.0%) of endometrial stromal sarcoma (ESS), 10 cases (25.0%) of malignant mixed mullerian tumors (MMMT) and 1 case (2.5%) of liposarcoma. The overall 5-year survival rate of MMMT was significantly worse than that of LMS and ESS, 26.7% vs 49.0% and 100.0%, respectively (P=0.0423). Classifying according to the FIGO surgical staging criteria, we found the following distribution; stage I of 26 cases (66.7%), stage II of 4 cases (10.3%), stage III of 5 cases (12.8%) and stage IV of 4 cases (10.3%). The overall 5-year survival rate of stage I and II was significantly better than stage III and IV, 61.8% vs 11.1% (P=0.0011). The overall 5-year survival rate of 14 patients less than 10 mitotic figures per 10 high-power microscopic fields had a tendency to good prognosis than that of 13 patients more than 10 mitotic figures per 10 high-power microscopic fields, 83.9% vs 38.5% (P=0.0568). The overall 5-year survival rate of 6 patients less than 35 U/mL of CA-125 had a tendency to good prognosis than that of 12 patients more than 35 U/mL of CA-125, 83.3% vs 20.8% (P=0.0580). However, menstrual status and treatment modality were not significant prognostic factors.
CONCLUSIONS
Uterine sarcoma are aggressive tumors with a poor prognosis. Age, histologic type, and stage were statistically significant prognostic factors for overall survival in uterine sarcomas.