Article Text
Abstract
Introduction Uterine sarcomas account for 3-5% of uterine malignancies, and have an overall poor prognosis. Stage and morphology are important prognostic factors. Surgery is the keystone in treatment and adjuvant treatment have effect in selected patients. The purpose of this study was to investigate the survival of patients with uterine sarcomas in Sweden 2010-2020 according to morphology, stage and treatment modalities.
Methods A total of 618 patients with uterine sarcoma were identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) from 2010 to 2020. Survival was analyzed according to stage, morphology and given treatment.
Results Overall survival (OS) after 1 and 5 years was 76% and 44% respectively. Survival was greatly impacted by stage and morphology. Endometrial stroma sarcoma had a 5-year OS of 84%, adenosarcoma 65%, leiomyosarcoma (LMS) 37%, undifferentiated uterine sarcomas 34% and unspecified sarcoma 12%. The 5-year OS for stage I LMS with primary open surgery was 53% (95% CI: 43 – 62), and for minimally invasive surgery (MIS) 77% (95% CI: 50 – 91). In LMS of all stages OS for surgery plus chemotherapy vs. surgery did not differ, HR 1.11 (CI 0.75 – 1.66). In patients with FIGO stage I, there was a reduced survival rate in patients that received chemotherapy in addition to surgery (p=0.015).
Conclusion/Implications Adjuvant chemotherapy do not improve survival in uterine sarcoma patients, neither in localized nor spread disease. MIS in early stage uterine sarcomas seems to be safe compared to open surgery.