Uterine adenosarcomas: A dual-institution update on staging, prognosis and survival

• Uterine AS require long term surveillance.
• Consider adjuvant treatment for uterine AS with sarcomatous overgrowth and myometrial invasion.
• Consider limited surgery for AS in pre-menopausal women (further data is needed).

ObjectiveUterine adenosarcomas (AS) are rare tumors thought to have a favorable prognosis. The aim of this study was to evaluate clinicopathological characteristics and treatment outcome in women with uterine AS.MethodsPatients with uterine AS were identified from the institutional databases at two regional cancer centers, Princess Margaret Hospital, Toronto and Vancouver General Hospital. All cases underwent specialist pathological review and were re-staged according to FIGO criteria (2009). Patient demographics, treatment data and outcomes were evaluated.ResultsBetween 1984 and 2010, 64 patients with confirmed AS were identified: 30 exhibited sarcomatous overgrowth (AS + SO). 47 patients presented with stage I disease: 27 IA and 18 IB. 57 of the 58 patients with known surgical management underwent hysterectomy: 55 having bilateral salpingo-oophorectomy, 12 having lymph node dissection. 14 patients received adjuvant treatment: 10 radiotherapy, 3 chemotherapy and 1 both. Sixteen of the 45 patients (35.6%) with follow-up recurred; median time to recurrence 21.2 months, range 2.1–87.8 months. Recurrence was associated with myometrial invasion (p = 0.05). Two of the 10 women (20%) with AS + SO receiving adjuvant treatment recurred compared to 9 of the 14 (64%) who did not. One of the 5 women (20%) with stage IB disease who received adjuvant treatment recurred (20%) compared to 6 of the 7 (85.6%) who did not.ConclusionsLong term surveillance is required given the variable time to recurrence. For those with AS + SO and myometrial invasion adjuvant treatment should be considered and further investigation of adjuvant strategies is warranted.