Uterine adenosarcoma: An analysis on management, outcomes, and risk factors for recurrence

- In women with uterine adenosarcoma, sarcomatous overgrowth is associated with worse progression-free, disease-specific, and overall survival.
- Surgical management of uterine adenosarcoma does not require routine lymphadenectomy as lymph node metastases are rare.
- Uterine adenosarcoma can recur many years after initial diagnosis, and thus prolonged surveillance of patients with this disease is necessary.

ObjectivesUterine adenosarcoma is a rare malignancy with little data on optimal management. We aimed to clarify the impact of adjuvant therapy in patients with uterine adenosarcoma and identify risk factors for recurrence and death.MethodsWe performed a retrospective review of patients undergoing primary evaluation and treatment for uterine adenosarcoma at a single institution from July 1982 through December 2011. Univariate and multivariate analyses were used to identify prognostic factors for progression-free survival (PFS) and overall survival (OS).ResultsWe identified 100 patients with uterine adenosarcoma, and 74 patients met the inclusion criteria. On multivariate analysis, sarcomatous overgrowth (SO) and lymphovascular space invasion (LVSI) were predictors of worse PFS and OS. Median PFS and OS were 29.4 and 55.4 months for patients with SO, compared to 105.9 and 112.4 months for patients without SO (PFS HR 2.58, 95% CI 1.37-4.84, p = 0.003; OS HR 2.45, 95% CI 1.26-4.76, p = 0.008). Among patients with stage I disease, 17 of 22 patients (77%) with SO and 8 of 37 patients (22%) without SO had a recurrence (p < 0.001). Among patients with stage I disease with SO, adjuvant therapy appeared to be associated with longer PFS and OS, but these differences were not statistically significant (PFS, 46.7 vs. 29.4 months, p = 0.28; OS, 97.3 vs. 55.4 months, p = 0.18).ConclusionIn patients with uterine adenosarcoma, the presence of SO or LVSI confers a higher risk of recurrence. We did not identify an optimal treatment strategy for patients with SO, but adjuvant therapy may be associated with prolonged PFS.