e23553 Background: Uterine sarcomas are rare gynecologic malignancies and are frequently misdiagnosed as benign uterine disease, which may lead to incomplete staging, delays, and suboptimal surgery. Methods: We performed a retrospective descriptive study of patients with uterine sarcoma discussed at a multidisciplinary tumor board (Oct/2014–Oct/2024). We analyzed tumor characteristics, diagnostic workup, surgical approach, time intervals, and treatments, and explored associations with relapse-free survival (RFS) and overall survival (OS). Survival was estimated using the Kaplan–Meier method and compared using Cox regression; categorical variables were compared using chi-square tests. Results: Thirty-one patients were included (median age 54.6±12.6 years). The most common presenting symptom was abnormal uterine bleeding (58.1%). Transvaginal ultrasound was the first imaging test in 64.5%. Abdominal staging imaging was completed in 67.7%, but only 32.3% underwent preoperative chest CT. Radiologically, 71% of lesions were interpreted as benign. Twenty-six patients underwent surgery; 26.9% had incomplete initial surgery (polypectomy, myomectomy, or morcellation), requiring reintervention. The most frequent histology was leiomyosarcoma (41.9%), followed by low-grade endometrial stromal sarcoma (19.4%), adenosarcoma (16.1%), and high-grade endometrial stromal sarcoma (12.9%). On surgical specimens, 32.3% were hormone receptor–positive and 38.7% had a high mitotic index (>10 mitoses per 10 high-power fields). Two patients received adjuvant radiotherapy. Five patients did not undergo surgery due to unresectable locally advanced disease (n=1) or metastatic disease (n=4). Among operated patients, 13 relapsed, 76.9% with oligoprogression (1–5 lesions). Relapse sites were lung (53.8%) and peritoneum (46.2%). First relapse treatment included surgery (38.5%), surgery plus chemotherapy (23.1%), chemotherapy (30.8%), and endocrine therapy (7.7%). In advanced stages, patients received a median of 2 systemic chemotherapy lines (range 0–5). High mitotic index versus low/unknown was associated with shorter RFS (median 31.3 vs 152.8 months; p=0.012), with no significant association with OS (p=0.39). No statistically significant associations with RFS or OS were observed for radiologic benign vs malignant suspicion, preoperative chest CT, tumor size, or symptom-to-surgery interval >12 months. Conclusions: In this real-world cohort, uterine sarcomas were frequently interpreted as benign on preoperative imaging and showed substantial variability in staging and initial surgical management. Standardized diagnostic pathways and increased radiologic suspicion may reduce incomplete upfront surgery and optimize multidisciplinary care.
Ovejas et al. (Thu,) studied this question.