Uterine carcinosarcoma, leiomyosarcoma and endometrial stromal sarcoma : Epidemiological, clinical and prognostic aspects

• Main Author: Koivisto-Korander, Riitta
• Other Authors: Grénman, Seija, University of Helsinki, Faculty of Medicine, Institute of Clinical Medicine, Helsingin yliopisto, lääketieteellinen tiedekunta, kliininen laitos, Helsingfors universitet, medicinska fakulteten, institutionen för klinisk medicin, Leminen, Arto
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: Helsingin yliopisto 2012
• Subjects: naistentaudit ja synnytykset; gynekologinen onkologia; Norway; Iceland
• Online Access: http://hdl.handle.net/10138/37096

Uterine carcinosarcoma (CS), leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS) have historically been considered as main subtypes of uterine sarcomas (USs). Depending on the classification, 3% to 9% of malignancies of the uterine corpus and about 1% of all female genital tract malignancies are USs. However, it has been estimated that USs account for nearly one third of deaths from uterine malignancies. The aims of these studies were to assess clinical behavior, survival, prognostic markers and epidemiological aspects of uterine CS, LMS and ESS. In a retrospective study we analyzed survival and prognostic markers (both clinical and immunohistochemical) in patients treated from 1990 to 2001 at Helsinki University Central Hospital (HUCH). In the epidemiological studies the incidence and occupational risk of uterine LMS and ESS were examined by using the NORDCAN and Nordic Occupational Cancer Study (NOCCA) databases. A cohort of 8606 cases of USs from 13 cancer registries was used to evaluate the risk of a second primary malignancy after the first primary US. This study was co-ordinated by the International Agency for Research on Cancer (IARC). The age-adjusted incidence of LMS was about 0.4 0.5 per 100 000 and that of ESS about 0.2 per 100 000 in Iceland, Denmark, Finland and Norway during the study period 1978 2007. Age-specific incidences were highest around menopause for both subtypes of USs. Shoe and leather workers, farmers and teachers showed elevated standardized incidence ratios (SIRs) as regards LMS. However, no occupations were associated with increased SIRs in connection with ESS. One hundred patients with uterine CS (n = 40), LMS (n = 39) and ESS (n = 21) were treated in our institution during 1990 2001. The 2-, 5-, and 10-year disease-specific survival rates were 64%, 56% and 38% for all subtypes grouped together and 5-year survival rates for each subtype separately were 49% (CS), 57% (LMS) and 65% (ESS). Stage, age, tumor size and delivery status were independently associated with survival ...