BMC cancer · 2026
Risk factors for recurrent cases of early-stage uterine sarcoma after complete surgical resection.
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Nagao Yukari, Yokoi Akira, Yoshida Kosuke, Yoshihara Masato, Tamauchi Satoshi, Yoshikawa Nobuhisa, Niimi Kaoru, Kajiyama Hiroaki
Аннотация
BACKGROUND: Uterine sarcoma has an inferior prognosis and high recurrence rate among gynecological malignancies, even in early-stage cases with complete resection. However, the risk factors for recurrence remain poorly understood. This study aimed to identify risk factors associated with recurrence in early-stage uterine sarcoma.
METHODS: Among 97 patients with uterine sarcoma treated at our institution between January 2007 and June 2023, we retrospectively investigated 55 patients of the following five histological types: uterine leiomyosarcoma (ULMS), low- or high-grade endometrial stromal sarcoma (LG-ESS or HG-ESS), adenosarcoma, and smooth muscle tumor of uncertain malignant potential (STUMP). Risk factors were compared between the recurrence and non-recurrence groups using univariate analysis, and recurrence rates, time to recurrence, progression-free survival (PFS), and overall survival (OS) were examined.
RESULTS: The median age of 55 patients was 48 years, and the most common initial symptom was abdominal pain or abdominal mass awareness (29.4%), followed by abnormal bleeding in 25.5% of the patients. The median tumor size was 9.7 cm, and stage I cases were 64.8% of the total. Histological types were 28 ULMS, 13 LG-ESS, 8 STUMP, 5 HG-ESS, and one adenosarcoma. Among stage I cases, ULMS had a recurrence rate of 81.3% with a median time to recurrence of 12.4 months, while LG-ESS had a recurrence rate of 30% with a median time to recurrence of 41.1 months. A high mitotic count was significantly associated with recurrence in stage I ULMS (p = 0.044). Other surgical pathological findings, such as lymphovascular space invasion, MIB-1 positive rate, and necrosis, and surgical factors, such as myomectomy and ovarian preservation, showed no statistically significant differences but were higher in the recurrence cases. The 5-year PFS rates in stage I ULMS and LG-ESS groups were 31.3% and 75%, and the 5-year OS rates were 68.5% and 100%, respectively.
CONCLUSIONS: In stage I ULMS, a high mitotic count was associated with an increased risk of recurrence after complete surgical resection.
METHODS: Among 97 patients with uterine sarcoma treated at our institution between January 2007 and June 2023, we retrospectively investigated 55 patients of the following five histological types: uterine leiomyosarcoma (ULMS), low- or high-grade endometrial stromal sarcoma (LG-ESS or HG-ESS), adenosarcoma, and smooth muscle tumor of uncertain malignant potential (STUMP). Risk factors were compared between the recurrence and non-recurrence groups using univariate analysis, and recurrence rates, time to recurrence, progression-free survival (PFS), and overall survival (OS) were examined.
RESULTS: The median age of 55 patients was 48 years, and the most common initial symptom was abdominal pain or abdominal mass awareness (29.4%), followed by abnormal bleeding in 25.5% of the patients. The median tumor size was 9.7 cm, and stage I cases were 64.8% of the total. Histological types were 28 ULMS, 13 LG-ESS, 8 STUMP, 5 HG-ESS, and one adenosarcoma. Among stage I cases, ULMS had a recurrence rate of 81.3% with a median time to recurrence of 12.4 months, while LG-ESS had a recurrence rate of 30% with a median time to recurrence of 41.1 months. A high mitotic count was significantly associated with recurrence in stage I ULMS (p = 0.044). Other surgical pathological findings, such as lymphovascular space invasion, MIB-1 positive rate, and necrosis, and surgical factors, such as myomectomy and ovarian preservation, showed no statistically significant differences but were higher in the recurrence cases. The 5-year PFS rates in stage I ULMS and LG-ESS groups were 31.3% and 75%, and the 5-year OS rates were 68.5% and 100%, respectively.
CONCLUSIONS: In stage I ULMS, a high mitotic count was associated with an increased risk of recurrence after complete surgical resection.