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Abstract：
BACKGROUND: Uterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients\' prognostic factors, treatment modalities, and oncological outcomes.
METHODS: A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis.
RESULTS: Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population\'s DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival.
CONCLUSIONS: Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.
METHODS: A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis.
RESULTS: Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population\'s DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival.
CONCLUSIONS: Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.
摘要：
背景：子宫肉瘤是一种罕见的侵袭性恶性肿瘤。由于其稀有性和各种组织学亚型，最佳管理和预后因素尚未得到很好的认可。本研究旨在探讨这些患者的预后因素，治疗方式，和肿瘤结果。
方法：对2010年1月至2019年12月在巴基斯坦一家三级医院诊断为子宫肉瘤并接受治疗的所有患者进行了单中心回顾性队列研究。使用STATA软件对数据进行分析，并对组织学亚型进行分层。使用Kaplan-Meier方法估计生存率。使用单变量和多变量分析估计95%CI的粗略和调整的风险比。
结果：在40名患者中，16人（40%）患有子宫平滑肌肉瘤（u-LMS），10（25％）患有高级别子宫内膜间质肉瘤（HGESS），8（20％）患有低度子宫内膜间质肉瘤（LGESS），6（15％）患有其他组织学亚型。所有患者的中位年龄为49（40-55.5）。37例（92.5%）患者接受了一期手术切除，24例(60%)患者接受辅助全身化疗.生存图显示总体人群的DFS为64个月，OS为88个月（p值=0.001）。所有患者的中位DFS为12个月,中位OS为14个月(p值=0.001)。在接受辅助全身化疗的患者中发现了一个小但显著的DFS获益，13.5个月对11个月（p值=0.001）。多因素Cox回归分析显示，大肿瘤大小和晚期FIGO分期是降低生存率的重要因素。
结论：子宫肉瘤是罕见的恶性肿瘤，预后较差。多重因素,包括肿瘤大小,有丝分裂计数,疾病的阶段，和子宫肌层侵入，影响生存结果。辅助治疗可以降低复发率并改善DFS，但不影响OS。
方法：对2010年1月至2019年12月在巴基斯坦一家三级医院诊断为子宫肉瘤并接受治疗的所有患者进行了单中心回顾性队列研究。使用STATA软件对数据进行分析，并对组织学亚型进行分层。使用Kaplan-Meier方法估计生存率。使用单变量和多变量分析估计95%CI的粗略和调整的风险比。
结果：在40名患者中，16人（40%）患有子宫平滑肌肉瘤（u-LMS），10（25％）患有高级别子宫内膜间质肉瘤（HGESS），8（20％）患有低度子宫内膜间质肉瘤（LGESS），6（15％）患有其他组织学亚型。所有患者的中位年龄为49（40-55.5）。37例（92.5%）患者接受了一期手术切除，24例(60%)患者接受辅助全身化疗.生存图显示总体人群的DFS为64个月，OS为88个月（p值=0.001）。所有患者的中位DFS为12个月,中位OS为14个月(p值=0.001)。在接受辅助全身化疗的患者中发现了一个小但显著的DFS获益，13.5个月对11个月（p值=0.001）。多因素Cox回归分析显示，大肿瘤大小和晚期FIGO分期是降低生存率的重要因素。
结论：子宫肉瘤是罕见的恶性肿瘤，预后较差。多重因素,包括肿瘤大小,有丝分裂计数,疾病的阶段，和子宫肌层侵入，影响生存结果。辅助治疗可以降低复发率并改善DFS，但不影响OS。
