(P 337) CLINICAL OUTCOME OF THE PATIENTS WITH HIGH GRADE UTERINE SARCOMA: A SINGLE CENTRE REAL WORLD EXPERIENCE

Objective: Uterine sarcoma is a rare tumour with unclear aetiology that originates from the connective tissue or smooth muscle of uterus and accounts for around 3-7 % among all uterine malignancies (Bužinskienė D, 2018). The diagnosis of uterine sarcomas is challenging due to non-specific presentation and limited imaging modalities. The mainstream of management and diagnostics remains pelvic surgery, however despite radical treatment, uterine sarcomas are associated with poor prognosis with early risk of local recurrence or distant metastasis and approximately 40 % of 5-year survival rate. (Song Z, 2020) (Hinchcliff E, 2022) (Huss A, 2022) (Kyriazoglou A, 2018). We have evaluated the outcomes of patients with high or intermediate grade uterine sarcoma post pelvic surgery, who was on surveillance between sarcoma and gynaecology team at a tertiary centre in Manchester, United Kingdom.

Methods: All patients who attended for follow-up post pelvic surgery in the medical oncology sarcoma clinic between January 2016 to December 2020 were retrospectively identified from the hospital database. Patients’ follow-up regime was alternative gynae and sarcoma surveillance 3 monthly till year 2 and then 6 monthly till year 5. Clinical records have been used to obtain histology, follow-up adherence and recurrence. The patients with low grade soft tissue sarcoma and FIGO stage IV at initial presentation has been excluded from the study. The cut off for data collection was 30th March 2023.

Results: A total of 45 patients were identified with high grade or intermediate grade uterine sarcoma consisting of 29 uterine leiomyosarcoma, 10 uterine adenosarcoma, 3 epithelioid stromal sarcoma, and 3 undifferentiated sarcoma. Out of 45 patients who were on surveillance between gynae and sarcoma team, 29 patients have developed either local recurrence and or metastasis to secondary sites. Majority of the patients developed either metastasis in lung and or recurrence in pelvic, peritoneum.
More than half of the patients (64%) were progressed during this 5-year surveillance period, with as early as immediately a month post-surgery to 54 months with a median time to progression of 10 months. Among the 29 patients, 20 patients (68%) developed recurrence or metastasis within the 1st year of follow-up, 2 patients in second year, and 2, 4, 1 patient in year three, four and five respectively. Out of 29 patients, 25 patients (86%) died during these follow-up period. 17 out of the 25 patients (68 %) dying within the 1st year of follow-up and 3 patients died within a month since recurrence. The median overall survival period was 7 months since recurrence and the overall 5-year survival rate is 44 %.

Conclusion: We found that the clinical outcomes in this cohort of patients with high grade uterine sarcoma were similar to previous studies. Despite radical treatment and active surveillance, the overall prognosis, and survivability are still poor.