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Uterine Sarcoma and Carcinosarcoma: A Two-Center Experience in Iran

Document Type : Middle East Special Report

Authors

1 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Epidemiology and Biostatistics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Uterine sarcomas (US) represent a rare and heterogeneous spectrum of tumors characterized by diverse clinical behaviors and tumor responses. This study aims to assess patient and tumor characteristics and oncologic outcomes.
Method: This historical cohort study encompassed all patients with histologically confirmed diagnoses of the US who were referred to two oncology centers affiliated with Mashhad University of Medical Sciences (Iran) between March 2011 and April 2020. Data analyses were conducted using STATA version 14.02. Survival estimation was carried out utilizing the Kaplan-Meier method. The significance level was established at 0.05.
Results: A total of 33 patients were included in this study, comprising 23 with US and 10 with carcinosarcoma (CS). The mean age was 49.3 years for CS and 62.4 years for US (P = 0.0001). Nearly all patients were overweight, with a mean body mass index of 27.1 (confidence interval: 25.6-28.7). The majority of patients were diagnosed at an early stage. The Federation of Gynecology and Obstetrics (FIGO) stage, patient's anemia, and surgical resection were identified as significant prognostic factors. The median overall survival was 50.88 ± 5.7 months. The survival rates at 2, 3, and 5 years were 75%, 56%, and 41%, respectively. No significant difference was observed between CS and US regarding overall and disease-free survival.
Conclusion: Despite the typical early-stage diagnosis for US patients, the 5-year survival rate remains low. This study underscores the pivotal role of FIGO stage, tumor size, and surgical resection as vital prognostic factors for survival.

Highlights

Sare Hosseini (PubMed)

Keywords

Main Subjects

How to cite this article:

Hosseini S, Arastouei S, Afzalaghaei M, Zarei E, Ahmadi SP. Uterine sarcoma and carcinosarcoma: A twocenter experience in Iran. Middle East J Cancer. 2024;15(3):234-41de Jong RA, Nijman HW, Wijbrandi TF, Reyners AK, Boezen HM, Hollema H. Molecular markers and clinical behavior of uterine carcinosarcomas: focus on the epithelial tumor component. Mod Pathol. 2011;24(10):1368-79. doi: 10.1038/modpathol.2011.88.. doi:10.30476/mejc.2023.98999.1924.

References
  1. Bužinskienė D, Mikėnas S, Drąsutienė G, Mongirdas M. Uterine sarcoma: a clinical case and a literature review. Acta Medica Litu. 2018;25(4):206-18. doi:10.6001/ACTAMEDICA.V25I4.3931.
  2. He X, Dong Q, Weng C, Gu J, Yang Q, Yang G. Trends in incidence, survival and initial treatments of gynecological sarcoma: a retrospective analysis of the United States subpopulation. BMC Womens Health. 2023;23(1):10. doi: 10.1186/s12905-023-02161-1.
  3. Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B. Uterine sarcoma: analysis of 13,089 cases based on surveillance, epidemiology, and end results database. Int J Gynecol Cancer. 2016;26(6):1098-104. doi:10.1097/IGC.0000000000000720.
  4. Wen KC, Horng HC, Wang PH, Chen YJ, Yen MS, Ng HT, et al. Uterine sarcoma Part I-Uterine leiomyosarcoma: The Topic Advisory Group systematic review. Taiwan J Obstet Gynecol. 2016;55(4):463-71. doi: 10.1016/j.tjog.2016.04.033.
  5. Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K. Uterine carcinosarcoma: Contemporary clinical summary, molecular updates, and future research opportunity. Gynecol Oncol. 2021;160(2):586-601. doi: 10.1016/j.ygyno.2020.10.043.
  6. Leigh AC, Stephanie VB, Linda RD. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol. 2015;137(3):581-8. doi: 10.1016/j.ygyno.2015.03.041.
  7. Schwartz SM, Weiss NS, Daling JR, Gammon MD, Liff JM, Watt J, et al. Exogenous sex hormone use, correlates of endogenous hormone levels, and the incidence of histologic types of sarcoma of the uterus. Cancer. 1996;77(4):717-24. doi: 10.1002/(sici)1097-0142(19960215)77:4<717::aid-cncr18>3.0.co;2-3.
  8. Lavie O, Barnett-Griness O, Narod SA, Rennert G. The risk of developing uterine sarcoma after tamoxifen use. Int J Gynecol Cancer. 2008;18(2):352-6. doi:10.1111/J.1525-1438.2007.01025.X.
  9. Felix AS, Cook LS, Gaudet MM, Rohan TE, Schouten LJ, Setiawan VW, et al. The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer. 2013;108(3):727-34. doi: 10.1038/bjc.2013.2.
  10. Jaakkola S, Lyytinen HK, Pukkala E, Ylikorkala O. Use of estradiol-progestin therapy associates with increased risk for uterine sarcomas. Gynecol Oncol. 2011;122(2):260-3. doi:10.1016/j.ygyno.2011.04.003.
  11. Hana C, D'Amato GZ. Uterine sarcomas, insight into its risk factors: A systematic review. J Clin Oncol. 2020;38(15):suppl.e23540. doi: 10.1200/jco.2020.38.15_suppl.e23540.
  12. Cheng G, Hu Y, Gong Y. Clinical manifestations and prognosis of unexpected uterine sarcoma of uterine fibroids in Tianjin China. BMC Womens Health. 2022;22(1):495. doi: 10.1186/s12905-022-02077-2.
  13. Gitas G, Ertan K, Baum S, Rody A, Pados G, Wihlfahrt K, et al. Effect of tumor morcellation in patients with early uterine sarcoma: a multicenter study in Germany. J Turk Ger Gynecol Assoc. 2022;23(2):75-82. doi: 10.4274/jtgga.galenos.2022.2021.9-17.
  14. Liu J, Wang Z. Advances in the preoperative identification of uterine sarcoma. Cancers (Basel). 2022;14(14):3517. doi: 10.3390/cancers14143517.
  15. Libertini M, Hallin M, Thway K, Noujaim J, Benson C, van der Graaf W, et al. Gynecological sarcomas: molecular characteristics, behavior, and histology-driven therapy. Int J Surg Pathol. 2021;29(1):4-20. doi: 10.1177/1066896920958120.
  16. Khan SR, Soomar SM, Asghari T, Ahmed A, Moosajee MS. Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years' clinical experience from a tertiary care center in Pakistan. BMC Cancer. 2023;23(1):510. doi:10.1186/s12885-023-11000-3.
  17. Rizzo A, Pantaleo MA, Saponara M, Nannini M. Current status of the adjuvant therapy in uterine sarcoma: A literature review. World J Clin Cases. 2019;7(14):1753-63. doi: 10.12998/wjcc.v7.i14.1753.
  18. de Jong RA, Nijman HW, Wijbrandi TF, Reyners AK, Boezen HM, Hollema H. Molecular markers and clinical behavior of uterine carcinosarcomas: focus on the epithelial tumor component. Mod Pathol. 2011;24(10):1368-79. doi: 10.1038/modpathol.2011.88.
  19. Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol. 2015;94(1):98-104. doi: 10.1016/j.critrevonc.2014.10.013.
  20. Lee JW, Ouh YT, Chang HK, Min KJ, Lee S, Hong JH, et al. Trends in gynecologic carcinosarcoma based on analysis of the Surveillance Epidemiology End Result (SEER) database. J Clin Med. 2023;12(3):1188. doi: 10.3390/jcm12031188.
  21. Singh R. Review literature on uterine carcinosarcoma. J Can Res Ther. 2014;10(3):461-8. doi: 10.4103/0973-1482.138197.
  22. Pradhan TS, Stevens EE, Ablavsky M, Salame G, Lee YC, Abulafia O. FIGO staging for carcinosarcoma: can the revised staging system predict overall survival? Gynecol Oncol. 2011;123(2):221-4. doi: 10.1016/j.ygyno.2011.08.007.
  23. Zhou JG, Zhao HT, Jin SH, Tian X, Ma H. Identification of a RNA-seq-based signature to improve prognostics for uterine sarcoma. Gynecol Oncol. 2019;155(3):499-507. doi: 10.1016/j.ygyno.2019.08.033.
  24. Song Z, Wang Y, Zhang D, Zhou Y. A novel tool to predict early death in uterine sarcoma patients: a surveillance, epidemiology, and end results-based study. Front Oncol. 2020;26(10):608548. doi: 10.3389/fonc.2020.608548.
  25. Alghamdi AH, Niyaz RI, Al-Jifree H, Khan MA, Alsalmi L, Alghamdi A. Prevalence of anemia among gynecologic cancer patients who received chemotherapy, radiotherapy, or a combination of both at King Abdulaziz Medical City, Jeddah. Cureus. 2021;13(8) :e17613. doi: 10.7759/cureus.17613.
  26. Cybulska P, Goss C, Tew WP, Parameswaran R, Sonoda Y. Indications for and complications of transfusion and the management of gynecologic malignancies. Gynecol Oncol. 2017;146(2):416-26. doi: 10.1016/j.ygyno.2017.05.010. Erratum in: Gynecol Oncol. 2017.
  27. Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO Uterine Sarcoma and Carcinosarcoma classification. Histopathology. 2006;48(1):3-12. doi: 10.1111/j.1365-2559.2005.02284.x.
  28. Pezzicoli G, Moscaritolo F, Silvestris E, Silvestris F, Cormio G, Porta C, et al. Uterine carcinosarcoma: an overview. Crit Rev Oncol Hematol. 2021;1;163:103369. doi: 10.1016/j.critrevonc.2021.103369.
  29. Cordoba A, Prades J, Basson L, Robin YM, Taïeb S, Narducci, et al. Adjuvant management of operated uterine sarcomas: A single institution experience. Cancer/Radiothérapie. 2019;23(5): 401-7. doi: 10.1016/j.canrad.2019.04.001.
  30. Mallmann P. Uterine sarcoma-difficult to diagnose, hard to treat. Oncol Res Treat. 2018; 41(11):674. doi: 10.1159/000494393.
  31. Li Y, Ren H, Wang J. Outcome of adjuvant radiotherapy after total hysterectomy in patients with uterine leiomyosarcoma or carcinosarcoma: a SEER-based study. BMC Cancer. 2019;19(1):697. doi: 10.1186/s12885-019-5879-7.
  32. Hao Z, Yang S. The role of postoperative radiotherapy in patients with uterine sarcomas: A PSM-IPTW analysis based on SEER database. Front Surg. 2022;9:985654. doi: 10.3389/fsurg.2022.985654.
  33. Du J, Cheng Y, Hu D, Xing Y, Yue L, He R, et al. A nomogram-based overall survival stratification to identify uterine sarcoma patients without distant metastases who may benefit from adjuvant radiotherapy. Gynecol Oncol. 2023;169:17-26. doi: 10.1016/j.ygyno.2022.11.023.
  34. Rizzo A, Nannini M, Astolfi A, Indio V, De Iaco P, Perrone AM, et al. Impact of chemotherapy in the adjuvant setting of early stage uterine leiomyosarcoma: a systematic review and updated meta-analysis. Cancers. 2020;12(7):1899. doi: 10.3390/cancers12071899.
  35. Meurer M, Floquet A, Ray-Coquard I, Bertucci F, Auriche M, Cordoba A, et al. Localized high grade endometrial stromal sarcoma and localized undifferentiated uterine sarcoma: a retrospective series of the French Sarcoma Group. Int J Gynecol Cancer. 2019;29(4):691-8. doi: 10.1136/ijgc-2018-000064.
  36. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16(2):170-99. doi: 10.6004/jnccn.2018.0006.
  37. Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv51-iv67. doi: 10.1093/annonc/mdy096. Erratum in: Ann Oncol. 2018;29(Suppl 4):iv268-iv269.
Middle East Journal of Cancer
Volume 15, Issue 3 - Serial Number 59
July 2024
Pages 234-241
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