Uterine Sarcoma: Clinicopathological Characteristics, Treatment and Outcome in Iran

Objective: Uterine sarcomas are rare and heterogeneous tumors with histopathological diversity characterizedby rapid clinical progression and a poor prognosis. The aim of this study was to investigate clinical andhistopathological characteristics together with treatment and outcome of Iranian patients with uterine sarcomas.Materials and methods: Records of 57 patients with histologically verified uterine sarcoma treated at the Valie-Asr Hospital were reviewed (1999-2004).
Results:The lesions were 19 leomyosarcoma (LMSs), 17 malignantmixed Mullerian tumors (MMMT), 16 endometrial stromal sarcomas (ESSs), 3 unspecified sarcomas, 2rabdomyosarcomas. Median age at diagnosis was 50 (17-81) years. Clinical stages (based on FIGO) were 30with stage I disease, 9 with stage II, 12 with stage III and 6 with stage IV. Only one patientdid not undergosurgery and most cases with LMS and ESS were treated with simple total hysterectomy (STH). Forty patients(out of 57) received adjuvant radiotherapy. The median follow-up period was 19 (2-96) months and mediandisease free period was 16 (1-86) months. The overall survival rates after 1, 2, and 5 years were 71%, 58% and52%, respectively. Survival was related to histological type of ESS (p=0.0018), grade I (p=0.0032) and earlystage (p=0.045) significantly, but was not linked to postoperative irradiation. However, local recurrence ratewas significantly improved after adjuvant radiotherapy. Twenty-one patients had relapse, 16 in the pelvic and 5in extrapelvic sites.
Conclusion: Based on the findings in this series, prognosis is dependent on histopathologicalsubtype, grade and tumor stage. Adjuvant radiotherapy decreases local recurrence rate, but without significantimpact on survival.