Clinicopathological Profile and Real-World Survival Outcomes in Pure Uterine Sarcomas

Background Pure uterine sarcomas are rare and biologically aggressive malignancies with diverse histologic subtypes and heterogeneous clinical behavior. Owing to their low incidence, prospective data guiding optimal management and prognostic stratification remain limited, particularly in real-world settings. Evaluating survival outcomes and recurrence patterns in institutional cohorts is essential to better understand prognostic factors, treatment associations, and disease behavior. This study aimed to analyze survival outcomes, recurrence patterns, and clinicopathological factors influencing prognosis in patients with uterine sarcoma treated at a tertiary care center. Methods We conducted a retrospective analysis of 81 patients with histologically confirmed pure uterine sarcoma as treated during the 10-year period of 2011-2020. Carcinosarcoma was not included in this study. Clinical details, histologic subtype, stage, surgical and adjuvant treatments, recurrence, and survival outcomes were assessed. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS), and univariate analysis was performed to identify factors associated with prognosis. Results The mean age at diagnosis was 48 years, and most patients were multiparous and postmenopausal. The most common histologic type was leiomyosarcoma (48.1%), followed by low-grade endometrial stromal sarcoma (ESS) (29.6%). Stage I was the most frequent (55.6%). About 32.1% received chemotherapy, 9.9% radiotherapy, and 7.4% hormonal therapy; half received no adjuvant treatment. Recurrence was observed in 44.4% of cases, most commonly involving the pelvis and lymph nodes, with the lungs and liver also affected. Median OS and DFS were 72 and 70 months, respectively. Patients with low-grade ESS and early-stage disease had better survival. Chemotherapy was associated with higher recurrence. Histologic subtype, stage, and adjuvant treatment significantly influenced outcomes. Conclusion Histologic subtype, disease stage, and type of adjuvant therapy were independently associated with survival and recurrence outcomes in our cohort of uterine sarcoma patients. Early-stage disease and low-grade tumors demonstrated more favorable survival patterns. Given the rarity and heterogeneity of uterine sarcomas, real-world survival analyses such as this study help refine prognostic stratification and inform individualized treatment strategies. These findings provide clinically relevant insights that may guide risk-adapted management in this challenging group of malignancies.