Retrospective analysis of 80 cases with uterine carcinosarcoma, leiomyosarcoma and endometrial stromal sarcoma in China, 1988-2007

OBJECTIVE

Uterine sarcomas are rare gynecological malignancies with poor prognosis and high mortality. We provides clinical information of uterine sarcoma patients at Changhai Hospital of Secondary Military Medical University in Shanghai, China, over a 20-year period.

DESIGN AND METHODS

Satisfied the criteria for the study, a total of 80 female patients with uterine sarcomas were retrospectively evaluated. Overall survival was analyzed by Kaplan-Meier method.

MAIN OUTCOME MEASURES

The following information was extracted from our medical records: age, presentations, blood types, stages, ultrasonographic results, therapies and follow-up.

RESULTS

Of the 80 patients, the mean age of onset was 57.3±2.03 years, and the highest frequency occurred in 51-60 age group. Endometrial stromal sarcoma was the most common histological type (47.5%). Even population of these patients presented was with early stage (I&II) and advanced stages (III&IV). Among 79 patients underwent primary surgery, 74 cases was hysterectomy and bilateral salping-ooophorectomy. Equal to disease-specific survival, overall survival rates at 1-, 3- and 5-year were 81.3%, 62.5% and 40% respectively. Age, menopausal status, blood type, stage, and pathologic types were all proved to be correlated with the survival.

CONCLUSION

Our retrospective data in part reflect clinical characteristics of uterine sarcoma in China, and form the basis for further concerning researches.

Incidence of uterine leiomyosarcoma and endometrial stromal sarcoma in Nordic countries: results from NORDCAN and NOCCA databases

OBJECTIVES AND STUDY DESIGN

Uterine sarcomas are an uncommon and heterogeneous group of malignancies. Their etiology is mainly unknown. Here, we analyzed trends in incidence and occupational variation in risk of uterine leiomyosarcomas (LMS) and endometrial stromal sarcomas (ESS) in the Nordic countries aided by NORDCAN and NOCCA (Nordic Occupational Cancer) databases.

MAIN OUTCOME MEASURES

Incidence rates per 100,000 and Standardized incidences rates (SIR) obtained from NORDCAN and NOCCA databases.

RESULTS

The incidence rates were about 0.3 per 100,000 for ESS and about 0.4 per 100,000 for LMS in Denmark, Finland, Iceland, and Norway. During the study-period (1978-2007), the incidence rates in each country were quite similar and constant. The age-specific incidence of LMS showed a peak around menopause. Significantly increased risk for LMS occurred in shoe and leather workers, farmers and teachers, whereas significantly low risk was detected with packers in the NOCCA data from Finland, Norway, and Sweden. For ESS no occupations showed either increased or decreased incidences.

CONCLUSIONS

The incidence trends of LMS and ESS in our study were constant in four Nordic countries over time. The elevated risk for LMS with women exposed to leather work and animal dust indicates further exploration.

Clinical characteristics of endometrial stromal sarcoma from an academic medical hospital in China

OBJECTIVES

The purpose of this study was to evaluate the clinical features, treatments, and outcomes of endometrial stromal sarcoma (ESS) in China.

METHODS

Seventy consecutive ESS patients were treated at Peking Union Medical College Hospital from 1983 to 2005, and 51 of them completed the treatment and follow-up. The demographic, clinicopathologic, treatment, and survival information was retrospectively reviewed. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression.

RESULTS

In all, the mean age of the patients was 43.5 years. Irregular vaginal bleeding and uterine enlargement were presented in 71.0% and 65.7% of the cases, respectively. Uterine cavity lesions were found in 17 patients (24.3%). Twenty-six cases (37.2%) were diagnosed preoperatively through diagnostic curettage. Among 51 patients who completed the treatment and follow-up in Peking Union Medical College Hospital, 37 were diagnosed as having low-grade ESS (LGESS) and 14 high-grade ESS, which is now classified as undifferentiated endometrial sarcoma (UES). The median overall survival time was 334 months, and the 5-year survival rate was 87.8%. Twenty-six of 51 patients, including 14 with LGESS and 12 with UES, developed disease recurrence. The tumor's classification, initial surgery, and adjuvant therapy were the factors related to the disease-free survival, whereas only the tumor's classification was associated with the overall survival.

CONCLUSIONS

Endometrial stromal sarcoma is a rare kind of uterine malignancy; the possibilities of preoperative diagnosis may be improved by diagnostic curettage. Low-grade ESS and UES represent 2 distinct clinical entities and should be treated as such. The tumor's classification may be the most important prognostic factor.

Cervical sarcomas: an analysis of incidence and outcome

OBJECTIVE

Cervical sarcomas are exceedingly rare neoplasms associated with a poor prognosis. The objective of this study was to examine the treatment and outcome of women with cervical sarcomas.

METHODS

A hospital-based tumor registry was searched to identify all patients with cervical sarcomas treated between 1986 and 2003. The medical records of all patients were reviewed. All pathologic specimens were reviewed by a single pathologist.

RESULTS

Among 1583 with cervical malignancies, 8 cervical sarcomas were identified. All patients presented with vaginal bleeding. The lesions were clinically staged as IB1 (2), IB2 (4), IIIA (1), and IIIB (1). Five of the tumors were carcinosarcomas. Other histologies included sarcoma NOS (12.5%), leiomyosarcoma (12.5%), and endometrial stromal sarcoma (12.5%). Initial treatment included surgery in 5 patients, radiation in 2, and chemoradiation in 1. Six patients were treated with curative intent, 5 received adjuvant therapy. While both patients treated palliatively died from progressive disease, the other 6 patients remain alive after a mean follow-up of 2.5 years. Two patients have recurred. One patient underwent a thoracotomy for an isolated pulmonary metastasis and is alive with no evidence of disease. The second patient developed pulmonary metastases and is alive 8 months after recurrence.

CONCLUSIONS

Cervical sarcomas are rare neoplasms. Most patients present with vaginal bleeding and a palpable cervical mass. While the optimal management of these tumors is uncertain, aggressive primary therapy can result in prolonged survival and cure.

Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999

OBJECTIVES

To determine the association of race with incidence, histology, treatment, and survival in women with uterine sarcoma during the period 1989-1999.

METHODS

Uterine sarcomas were defined as leiomyosarcoma, carcinosarcoma, high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified (NOS). We used cases from Surveillance, Epidemiology, and End Results (SEER) program to compare uterine sarcoma among women >35 years of age. Using data from 1989 to 1999, we compared race-specific age-adjusted incidences, histological distributions, extent of disease at diagnosis, and race-specific survival.

RESULTS

During the period of 1989-1999, 2677 women were diagnosed with uterine sarcoma, 2098 (78%) of whom were white and 420 (16%) of whom were black, and 159 (6%) of whom were of other races. The overall age-adjusted incidence for blacks was twice that of whites and more than twice that of women of other races (7/10(5) vs. 3.6/10(5) vs. 2.7/10(5), P < 0.0001). Racial differences in the incidence of uterine sarcoma existed for leiomyosarcoma (1.51/10(5) for blacks vs. 0.91/10(5) for whites, and 0.89 for women of other races, P < 0.01) and carcinosarcoma (4.3/10(5) for blacks, vs. 1.7/10(5) for whites, and 0.99 for women of other races, P < 0.001), but not for other histological types. Blacks with stage II disease were less likely to receive radiation in addition to surgery compared to whites (33% vs. 54%, P < 0.05). Five-year relative survival of patients with disease beyond the uterus was significantly longer for those that received radiation and surgery compared to those that received surgery alone. There were no racial differences in survival for women that received similar therapy.

CONCLUSIONS

Adjuvant therapy improved survival for women with stage II-IV disease. Survival of black and white patients who received comparable treatment was similar.

Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality

A total of 1042 patients diagnosed with uterine sarcoma were reported to The Cancer Registry of Norway from 1956 to 1992. In the present study long-term trends in incidence, survival and mortality were analysed. To evaluate the effect of the introduction of chemotherapy in the treatment of this disease, special attention was paid to the time periods 1971-1975 and 1983-1987. The reporting system is based on pathology reports, clinical records and death certificates. Histological type, diagnostic period, clinical stage and age were included in the study. The analysis of survival was based on 5-year relative survival. Both the incidence and mortality rate of uterine sarcomas in Norway doubled in the time period 1956-1992, mainly due to an increase of carcinosarcomas. The overall annual incidence rate in 1987-1992 was 1.7 per 100000 females in the population per year, accounting for 9.7% of all uterine corpus malignancies. In 1990-1992, 26% of the mortality due to uterine corpus malignancies was caused by sarcoma. No change in 5-year survival was seen after the introduction of chemotherapy in the treatment of the disease (P = 0.35). Stage (P < 0.001) and age (P < 0.001) were both important prognostic factors. Patients with an endometrial stromal sarcoma (P < 0.001) had a more favourable prognosis than those with other histological types.

Uterine cancer--the KK Hospital experience

Kandang Kerbau Hospital saw 165 new cases of uterine cancers over the 4-year period from 1991 to 1994. The median age of presentation was 54.1 years and 10.9% of these cases occurred in those aged less than 40 years, unlike the corresponding figures of 61 years and less than 5%, respectively, which are often quoted for endometrial cancers in standard textbooks. Endometrioid adenocarcinoma was the commonest type of uterine cancer seen in our population (75.2%) as in other series. However, we had fewer cases of adenoacanthoma (1.4%) and adenosquamous carcinoma (1.4%) but more cases of uterine sarcoma (11.5%) than is usually reported. 6.7% of our patients had papillary serous adenocarcinoma and 3.0% had clear cell carcinoma. These 2 sub-types are associated with poorer prognosis and there is a need to increase awareness of their existence in our local population as their management differs from that for the usual endometrioid adenocarcinoma. We had fewer patients with stage I disease (53.3%) but more patients with stage III disease (22.4%). This is most likely due to the use of surgico-pathological staging currently as opposed to the clinical staging used previously which led to the under-staging of a proportion of patients.

Endometrial stromal sarcoma: analysis of treatment failures and survival

The objective of this retrospective multicenter study was to assess the rates, times, and sites of recurrences of 26 patients with low-grade endometrial stromal sarcomas (ESS) (<10 mitoses per 10 high-power fields (HPF) and 40 patients with high-grade ESS (>10 mitoses/10 HPF). Surgery was the initial therapy for all patients. Postoperative treatment was given without well-defined protocols. The median follow-up of survivors was 92 months (range, 4-167). Low-grade ESS: Of the 20 patients with disease confined to the uterus, 5 (25.0%) developed pelvic recurrence after a median of 36 months (range, 4-108). Of the 6 patients with disease outside the uterus, only one recurred in the pelvis after 93 months. High-grade ESS: Of the 20 patients with disease confined to the uterus, 11 (55.0%) developed recurrent disease after a median of 5 months (range, 2-76). The relapse occurred in the pelvis in 3 patients, in upper abdomen in 3, in upper abdomen and extraabdominal sites in 1, and in the pelvis and upper abdomen or extraabdominal sites in 4. Of the 12 patients with extrauterine disease confined to the pelvis, 9 (75.0%) developed recurrent disease after a median of 12 months (range, 1-49). The relapse occurred in the pelvis in 3 patients, in extraabdominal sites in 3, and in the pelvis and upper abdomen or extraabdominal sites in 3. Of the 8 patients with extrauterine disease outside the pelvis, 7 died of disease and 1 is currently alive with progressive disease after 24 months. The disease-free survival was significantly better for low-grade than that for high-grade ESS (P = 0.0001). By log-rank test the disease-free survival of high-grade ESS patients was related to stage (P = 0.0466) and mitotic count (P = 0.0014), but not to age. Cox model showed that mitotic count was the only independent prognostic variable for high-grade ESS (P = 0.006). In conclusion, low-grade and high-grade ESS have a completely different biological aggressiveness and clinical behavior.

[Uterine sarcoma. Apropos of 25 cases]

This study involved an analysis of 25 cases of sarcoma of the uterine body collected at the Gynecology and Obstetrics Clinic of the Ibn Rochd CHU teaching hospital, Casablanca (Morocco) during a 15-year period (1977-1992). These are unusual malignant tumours (accounting for only 0.9% of uterine cancers) which occur after the menopause and have an appalling prognosis. Metrorrhagia was the most common alerting symptom. Presurgical diagnosis was difficult and uterine sarcoma was usually identified during surgery. The most common histological type encountered was leiomyosarcoma. Treatment was primarily surgical: total hysterectomy combined with bilateral appendectomy (20 cases), with radiotherapy (5 cases) or with adjuvant chemotherapy (1 case). Radiotherapy was the only treatment in 2 patients. The survival rate was low: 10% after 2 years, 5% after 5 years. Age, histological type, extent of the tumor and method of treatment were all recognised as prognostic factors. One interest of this work is to recall the existence and the severity of this pathology in those periods of endoscopic games and excessive conservative treatments.