Introduction To examine the histopathological features and treatment modalities in patients with uterine sarcoma according to subgroups (uterine leiomyosarcoma, low grade/high grade endometrial stromal sarcoma, adenosarcoma, undifferentiated uterine sarcoma) and to determine the factors affecting mortality rates.

Methods We retrospectively evaluated patients diagnosed with uterine sarcoma in our eight multicenter institutions between March 2012 and December 2021. We compared the clinicopathological characteristics and treatment modalities of the subgroups and investigated the factors affecting mortality rates using logistic regression analysis.

Results In the entire US group, the rate of 5-year OS was 51.2% and the rate of DFS was 39.9%. There was no difference between the subgroups in terms of age, body mass index, menopausal status, comorbidity, presenting complaint, primary diagnosis, surgical treatment protocol, adnexal and lymph node involvement and tumor size (p> 0.01). High NLR was significantly associated with worse DFS (p = 0.007) and OS (p = 0.039). Advanced stage (p = 0.017) and high mitotic index (p = 0.036) retained their prognostic significance for DFS. Other clinical variables, including PLR, CA125, and lactate dehydrogenase (LDH) failed to show significant impact.

Conclusion/Implications Uterine sarcoma is an aggressive cancer with poorer survival in this specific cohort than has been described in other contemporary cohorts. Despite their different histopathological features, subgroups do not have distinctive features such as demographic features, presenting complaints, primary diagnosis and surgical treatment protocols. Therefore, prospective randomized clinical studies should be performed to evaluate the prognostic influencing factor and the value of adjuvant treatments for patients with uterine sarcoma.