Adult urologic sarcomas: a single institution experience over 25 years

Genitourinary (GU) sarcomas are rare soft tissue malignancies, comprising around 2% of all GU cancers. Due to their rarity, limited data exist on optimal management and long-term outcomes. This study presents a 25-year single-institution experience, evaluating clinical presentation, treatment strategies, and survival outcomes, aims to identify trends over time and potential predictors of prognosis.

A retrospective review was conducted of patients aged ≥18 years diagnosed with GU sarcomas at the University of Iowa Hospitals and Clinics (1998-2023). Data on tumor subtype, staging, histopathology, treatment modalities, and survival outcomes were analyzed. Kaplan-Meier analysis estimated recurrence-free survival (RFS) and overall survival (OS).

Among 33 cases, the most common presentations in order of frequency were liposarcoma (LPS) (n = 15), leiomyosarcoma (LMS) (n = 12), rhabdomyosarcoma (RMS) (n = 5), and angiosarcoma (n = 1). Paratesticular tumors (n = 23) were most frequent, followed by bladder (n = 5), prostate (n = 2), and kidney (n = 2). The median age was 51 for LMS, 60 for LPS, and 24 for RMS. LMS had higher stage (66.67%), grade (83.33%), recurrence (25.00%), and mortality (41.67%) rates compared to LPS (recurrence: 13.33%, mortality: 20.00%). At 36 months, RFS was 63% (95% CI: 39%-79%), and OS was 81% (95% CI: 57%-92%) for the entire cohort. Follow-up duration was 19.9 months for LMS and 33.8 months for LPS.

Surgical resection remains the mainstay of treatment for GU sarcomas. Margin status, tumor grade, and size are key prognostic factors. LMS carries the highest recurrence risk, and RMS exhibits aggressive progression. Further investigation into targeted therapies is warranted to improve outcomes.