Abstract

Background: Uterine sarcomas (US) are rare malignancies with diverse histopathological subtypes. Their low incidence limits the availability of robust evidence, leaving many therapeutic strategies unresolved. This study reports the experience of a tertiary cancer center.

Methods: We retrospectively analyzed patients diagnosed with high-grade US between 2008 and 2024. Demographics, treatment modalities, and outcomes were evaluated. Survival was estimated using the Kaplan–Meier method, and prognostic factors were assessed with Cox regression analysis.

Results: A total of 82 patients were included, of whom 53 (64.6%) presented with localized disease. The median age at diagnosis was 51.8 years (range 22.3–80.9), and most patients had ECOG performance status 0–1 (74%). Leiomyosarcoma was the predominant histology (92.2%). At diagnosis, 39.0% were FIGO stage I, 7.4% stage II, 6.1% stage III, 1.2% stage IVA, and 34.1% stage IVB.

Among patients with localized disease, 67.9% underwent hysterectomy with bilateral salpingo-oophorectomy, and 86.7% achieved R0 resection. Adjuvant therapy was administered to a minority: 17% received chemotherapy (mainly doxorubicin plus ifosfamide), 22.6% radiotherapy, and

13.2% brachytherapy. After a median follow-up of 52 months, 54.7% relapsed, predominantly at distant sites (75.9%), most often the lungs. Median disease-free survival was 58.5 months (IQR 9.7–154.8), and overall survival was 105.2 months (IQR 37.4–121.3). FIGO stage was the only factor significantly associated with recurrence risk (HR 5.2 for stage III–IVA vs. I–II; 95% CI 1.86–14.49; P=0.002). Lymphadenectomy, adjuvant chemotherapy, and adjuvant radiotherapy did not impact recurrence risk.

Among 57 patients with metastatic disease, 47 received first-line therapy, most frequently gemcitabine plus docetaxel (59.6%). Disease progression accounted for 42.6% of treatment discontinuations. Median overall survival for this group was 24.7 months (IQR 11.4–35.7).

Conclusions: Despite high rates of complete resection, more than half of patients with localized disease relapsed, mainly at distant sites, and survival for metastatic disease remained poor. Current local and systemic approaches provide limited benefit. Novel systemic therapies and integration of molecular profiling are needed to improve outcomes in this rare malignancy.