OUTCOMES AFTER PRIMARY SURGERY OF UTERINE SARCOMA: RETROSPECTIVE CASE SERIES STUDY.

Field: Medicine (Health Sciences)

IntroductionUterine sarcomas are rare tumors, they constitute 8% of uterine tumors. There are different subtypes of uterine sarcomas based on the hystopathological exam: leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma and adenosarcoma. Natural history and response to the treatment is different depending on the tumor subtype. More evidence is needed to clarify and individualize the best treatment in each case.We sought to determine the time to recurrence and survival after primary surgical treatment of uterine sarcomas in our hospital.Patients and methodsA retrospective, case series study was performed including all patients who were diagnosed of uterine sarcoma and underwent primary surgical treatment in two tertiary hospitals between October 2010 and January 2017. Demographic data, hystophatology of the tumour, stage at the diagnosis, surgical procedures, complications and adjuvant therapies were collected from the patient records. Time to recurrence and survival were the main outcomes of the study.ResultsEight patients received surgical treatment due to the diagnosis of uterine sarcoma in this period. Mean age at diagnosis was 46 (22-62) years. The most frequent complaint that led to the diagnosis was abnormal uterine bleeding.Radical abdominal hysterectomy was the main surgical procedure. One patient also received pelvic and para-aortic lymphadenectomy and another one additional extensive surgical procedures including omentectomy and appendicectomy. All the patients received adjuvant chemotherapy and radiotherapy.Regarding to hystopathologic exam, 50% of sarcomas were endometrial stromal sarcoma (ESS) and 37,5% Leiomyosarcoma (LMS) and one case of undifferenciated uterine sarcoma (US) (12,5%). All cases except for one ESS were high grade sarcomas.Following FIGO classification of uterine sarcomas, stage at diagnosis was more advanced in patients with US and LMS. The patient with the US and two of LMS presented stage IV and the other one with LMS stage IIIB, whereas patients with EES were diagnosed in a lower stage, three presented stage IB and the other one stage IIIC. Mean time until the first recurrence was 21,4 (6-68) months. All patients with LMS and US decesased and the overall survival was 12,75 (2-34) months. One patient with ESS did not survive after a surgery complication with a massive bleeding. The other three patients with ESS are still alive after more than two years since diagnosis. The patient with the low grade ESS, had presented four recurrences, and the two others had presented one and two recurrences, all cases treated with surgery and chemotherapy. Five year survival rate for EES was 66,7%.ConclusionsBeing conscious of the limitations of our study, the small size and the heterogeneity of our series our findings suggests that uterine sarcoma is a devastating disease, with a poor prognosis and high local recurrence and metastatic rates. Nowadays treatment is based on radical surgery, chemotherapy and radiotherapy, however, further studies are needed to identify new therapies.