Evaluation of surgical approach and adjuvant therapy in uterine sarcomas: an 11-year population-based study

BACKGROUND: Uterine sarcomas are rare and high-quality evidence regarding optimal treatment is limited and difficult to produce. METHODS: A total of 618 patients with uterine sarcoma were identified in the Swedish Quality Registry for Gynecologic Cancer (SQRGC) from 2010 to 2020. Survival was analyzed according to stage, histology and treatment modality. RESULTS: The incidence of uterine sarcoma was 1.43 per 100,000 woman-years. Overall survival after 1 and 5 years was 75.9% and 44.1% respectively, with survival primarily influenced by stage, age and histological type. Adjuvant chemotherapy was not associated with improved survival, neither in localized nor advanced disease. Among patients with stage I disease, overall survival was higher after minimally invasive surgery (MIS) 81%, compared to open surgery 57% (p = 0.007); however, after entropy balancing no significant difference was observed. CONCLUSIONS: MIS showed comparable survival to open surgery in early-stage uterine sarcomas, with a non-significant trend toward improved survival. Entropy balancing supported this finding but residual confounding and selection bias cannot be excluded due to the observational design. Adjuvant chemotherapy was not associated with improved survival in uterine sarcoma patients overall or in leiomyosarcomas specifically, neither in localized nor advanced disease.