Introduction/Background Uterine sarcomas are a heterogeneous group of mesenchymal gynecological malignancy with low incidence and lack of high level evidence supporting its management esp. in the South Asian population. This study aimed to provide a basis for the management and prognosis of uterine sarcoma in this population.
Methodology Retrospective analysis was done for all patients diagnosed with uterine sarcoma at Tata medical center between August 2011–2022. Clinico-pathological data, treatment and outcomes were recorded and statistically analysed..
Results Data was retrieved for 85 women (9 excluded for incomplete data; N=76). Study cohort included patients from India (80%) and neighboring countries. Median age was 48.5±11.8 years at diagnosis. Most common (MC) symptoms included menorrhagia (31.6%), pain abdomen (27.6%) and post menopausal bleeding (23.7%). Only 9.2% patients could be diagnosed pre-operatively. MC pathological subtypes were leiomyosarcoma (LMS; 56.6%) and low grade endometrial stromal sarcoma (LG ESS; 27.6%). 10.5% needed completion surgery while 50% cases required adjuvant treatment. 36.8% (28/76) developed recurrence, mostly in LMS subtype (75%). MC sites were pelvis (46.4%) and lungs (39.2%). 19.7% cases were lost to follow-up. Median disease free survival (DFS) and overall survival (OS) was 21.0 months (mos) and 54.0 mos in the overall population. In the LMS subtype, median DFS was 11.0 mos with hazards ratio (HR) of 4.2 (95% CI 2.2–8.0 and P value 0.0002) as compared to LG ESS. OS for LMS subtype was 24.0 mos with HR of 3.9 (95% CI 1.9–7.8 and P value of 0.0055) compared to LG ESS .
Conclusion Our study is one of the largest study in South Asian population conducted so far and in part reflect clinical characteristics of uterine sarcoma and form the basis for further concerning research. Pre-operative diagnosis remains a challenge. Large prospective studies with long term follow up are needed to guide treatment options in uterine sarcomas.
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