Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 4 ( July-August, 2022 ) > List of Articles

ORIGINAL RESEARCH

Clinicopathological Profile, Surgical Practices and Outcomes of the Patients with Uterine Sarcoma: A Single Institutional Study from Eastern India

L Kavin Nilavu, Manoranjan Mahapatra, Janmejaya Mohapatra, Jita Parija, Bhagyalaxmi Nayak, Ashok Kumar Padhy, Kusumbati Besra

Keywords : Adenosarcoma, Endometrial stromal sarcoma, Fertility sparing surgery, Leiomyosarcoma, Ovarian preservation, Uterine sarcoma, Uterine smooth muscle tumors of uncertain malignant potential

Citation Information : Nilavu LK, Mahapatra M, Mohapatra J, Parija J, Nayak B, Padhy AK, Besra K. Clinicopathological Profile, Surgical Practices and Outcomes of the Patients with Uterine Sarcoma: A Single Institutional Study from Eastern India. J South Asian Feder Obs Gynae 2022; 14 (4):415-419.

DOI: 10.5005/jp-journals-10006-2078

License: CC BY-NC 4.0

Published Online: 22-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: The study aimed to analyze the clinicopathological profile, surgical practices, and survival outcomes of the patients with uterine sarcoma in eastern India. Background: Uterine sarcomas are a rare entity among gynecological malignancies with a very unfavorable prognosis. Due to its rarity, there is no consensus on a standardized treatment approach. Materials and methods: A retrospective analysis of all patients with a histopathological diagnosis of uterine sarcomas who were treated in our institute from 2012 to 2016 was done. The clinical parameters, treatment given, histopathological report, stage, and follow-up details of all patients were reviewed. Survival analysis was done using Kaplan–Meier method. Results: From 2012 to 2016, 40 patients with a diagnosis of uterine sarcoma were recorded. The median age of the patients was 44 years (range, 18–68 years). The youngest patient who got treated was an 18-year-old with low-grade endometrial stromal sarcoma (LGESS) with stage IIIC disease. Majority of the patients presented with abnormal uterine bleeding (60%) followed by abdominal pain (30%). Low-grade endometrial stromal sarcoma (42%) was the most frequent histological subtype of uterine sarcoma encountered followed by leiomyosarcoma (LMS) (40%), adenosarcoma (AS) (7.5%), undifferentiated endometrial sarcoma (UES) (5%), high-grade endometrial stromal sarcoma (HGESS) (2.5%), and uterine smooth muscle tumor of uncertain malignant potential (STUMP) (2.5%). Majority of the patients were diagnosed at stage I (92.5%) and only 2.5% of patients had stage IIIC disease. The patients were followed up for a median duration of 15 (range, 4–180) months. The median survivals of the patients diagnosed with different histological subtypes were 32, 11, 4, 9.5, 26, and 42 months for LGESS, LMS, HGESS, UES, AS, and STUMP, respectively. Median disease-free survival (DFS) for the entire cohort of uterine sarcoma was 32 months, and median overall survival (OS) was 57 months. Conclusion: Uterine sarcoma, when diagnosed even at an early stage was associated with increased recurrence rate and mortality. Clinical significance: Due to its aggressive behavior, an early diagnosis and a multimodal treatment approach should be considered.


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  1. Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 1993;71(Suppl. 4):1702–1709. DOI:10.1002/cncr.2820710440.
  2. Kurman RJ, Carcangiu ML, Herrington CS, et al., editors. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC Press; 2014. pp.135–147.
  3. Oliva E. Cellular mesenchymal tumors of the uterus: a review emphasizing recent observations. Int J Gynecol Pathol 2014;33(4):374–384. DOI:10.1097/PGP.0000000000000141.
  4. Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol 1990;21(4):363–381. DOI:10.1016/0046-8177(90)90198-e.
  5. Chang KL, Crabtree GS, Lim-Tan SK, et al. Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases. Am J Surg Pathol 1990;14(5):415–438. DOI:10.1097/00000478-199005000-00002.
  6. Lee CH, Mariño-Enriquez A, Ou W, et al. The clinicopathologic features of YWHAE-FAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol 2012;36(5):641–653. DOI:10.1097/PAS.0b013e31824a7b1a.
  7. Lavie O, Barnett-Griness O, Narod SA, et al. The risk of developing uterine sarcoma after tamoxifen use. Int J Gynecol Cancer 2008;18(2):352–356. DOI:10.1111/j.1525-1438.2007.01025.x.
  8. Abeler VM, Røyne O, Thoresen S, et al. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology 2009;54(3):355–364. DOI:10.1111/j.1365-2559.2009.03231.x.
  9. Prat J, D’Angelo E. Uterine sarcomas: a review. Gynecol Oncol 2010;116(1):131–139. DOI: 10.1016/j.ygyno.2009.09.023.
  10. Hosh M, Antar S, Nazzal A, et al. Uterine sarcoma: analysis of 13,089 cases based on surveillance, epidemiology, and end results database. Int J Gynecol Cancer 2016;26(6):1098–1104. DOI:10.1097/IGC.0000000000000720.
  11. Momtahan M, Emami F, Sari Aslani F, et al. Evaluation of treatment results and prognostic factors of uterine sarcoma: a single-center experience. J Chin Med Assoc JCMA 2020;83(1):84–88. DOI:10.1097/JCMA.0000000000000188.
  12. Nusrath S, Bafna S, Rajagopalan R, et al. Uterine sarcomas: experience from a tertiary cancer care center from India. Indian J Surg Oncol 2019;10(2):342. DOI:10.1007/s13193-018-0860-5.
  13. Kyriazoglou A, Liontos M, Ziogas DC, et al. Management of uterine sarcomas and prognostic indicators: real world data from a single-institution. BMC Cancer 2018;18(1):1247. DOI:10.1186/s12885-018-5156-1.
  14. Durnali A, Tokluoğlu S, Özdemir N, et al. Prognostic factors and treatment outcomes in 93 patients with uterine sarcoma from 4 centers in Turkey. Asian Pac J Cancer Prev 2012;13(5):1935–1941. DOI:10.7314/apjcp.2012.13.5.1935.
  15. Wais M, Tepperman E, Bernardini MQ, et al. A multicentre retrospective review of clinical characteristics of uterine sarcoma. J Obstet Gynaecol Can 2017;39(8):652–658. DOI:10.1016/j.jogc.2017.03.090.
  16. Ruiz-Minaya M, Mendizabal-Vicente E, Vasquez-Jimenez W, et al. Retrospective analysis of patients with gynaecological uterine sarcomas in a tertiary hospital. J Pers Med 2022;12(2):222. DOI:10.3390/jpm12020222.
  17. Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynecol Obstet 2018;143(Suppl. 2):51–58. DOI:10.1002/ijgo.12613.
  18. Hoellen F, Waldmann A, Benthin S, et al. The role of lymphadenectomy in uterine sarcoma: a clinical practical approach based on retrospective analysis. Anticancer Res 2014;34(2):985–993. PMID: 24511044.
  19. Kapp DS, Shin JY, Chan JK. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer 2008;112(4):820–830. DOI:10.1002/cncr.23245
  20. Dafopoulos A, Tsikouras P, Dimitraki M, et al. The role of lymphadenectomy in uterine leiomyosarcoma: review of the literature and recommendations for the standard surgical procedure. Arch Gynecol Obstet 2010;282(3):293–300. DOI:10.1007/s00404-010-1524-z.
  21. Diesing D, Cordes T, Finas D, et al. Endometrial stromal sarcomas: a retrospective analysis of 11 patients. Anticancer Res 2006;26(1B):655–661. PMID: 16739335.
  22. Forde GK, Carlson JW, Downey GO, et al. A quality process study of lymph node evaluation in endometrial cancer. Int J Gynecol Pathol 2011;30(4):335–339. DOI:10.1097/PGP.0b013e31820dc39d.
  23. Shah JP, Bryant CS, Kumar S, et al. Lymphadenectomy and ovarian preservation in low-grade endometrial stromal sarcoma. Obstet Gynecol 2008;112(5):1102–1108. DOI:10.1097/AOG.0b013e31818aa89a.
  24. Leitao MM, Sonoda Y, Brennan MF, et al. Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus. Gynecol Oncol 2003;91(1):209–212. DOI:10.1016/s0090-8258(03)00478-5.
  25. Chu MC, Mor G, Lim C, et al. Low-grade endometrial stromal sarcoma: hormonal aspects. Gynecol Oncol 2003;90(1):170–176. DOI:10.1016/s0090-8258(03)00258-0.
  26. Yoon A, Park JY, Park JY, et al. Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases. Gynecol Oncol. 2014;132(1):70-75. DOI:10.1016/j.ygyno.2013.10.029.
  27. Li AJ, Giuntoli RL 2nd, Drake R, et al. Ovarian preservation in stage I low-grade endometrial stromal sarcomas. Obstet Gynecol 2005;106(6): 1304-1308. DOI:10.1097/01.AOG.0000185511.91694.1e.
  28. Li N, Wu LY, Zhang HT. Treatment options in stage I endometrial stromal sarcoma: a retrospective analysis of 53 cases. Gynecol Oncol 2008;108(2):306–311. DOI:10.1016/j.ygyno.2007.10.023.
  29. Littell RD, Tucker LY, Raine–Bennett T, et al. Adjuvant gemcitabine–docetaxel chemotherapy for stage I uterine leiomyosarcoma: trends and survival outcomes. Gynecol Oncol 2017;147(1):11–17. DOI:10.1016/j.ygyno.2017.07.122.
  30. Seagle BLL, Sobecki–Rausch J, Strohl AE, et al. Prognosis and treatment of uterine leiomyosarcoma: a National Cancer Database study. Gynecol Oncol 2017;145(1):61–70. DOI:10.1016/j.ygyno.2017.02.012.
  31. Giuntoli RL, Metzinger DS, DiMarco CS, et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 2003;89(3):460–469. DOI:10.1016/s0090-8258(03)00137-9.
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