Prognostic Factors in Uterine Sarcomas: A Clinicopathologic and Immunohistochemical Study

  • Abdul Mohsen Al Kushi
  • Ahmad Omair
  • Haitham Arabi
  • Motasim Badri
Keywords: Uterine sarcomas, prognostic factors, immunohistochemistry, survival, mitotic index

Abstract

Background: Uterine sarcomas are rare malignant tumors histologically categorized into high-grade and low-grade sarcomas (HGS & LGS).

Objective: To examine the prognostic relevance of clinicopathological and immunohistochemical features for this rare group of tumors.

Materials and Methods: Clinicopathological data including age, follow-up, parity, tumor cell type, lymphovascular invasion, nuclear grade, stage and mitotic index was obtained for 28 cases treated at our institute. HGS (n=22) included 11 each of leiomyosarcoma (LMS), and carcinosarcoma (CS). LGS (n=6) included 3 each of Müllerien adenosarcoma (MAS) and endometrial stromal sarcoma (ESS). Sections were immunostained with antibodies for p53, Bcl-2, ER, HER-2 and c-Kit. The data was statistically analyzed for association between these factors and disease-free survival.

Results: Twelve (42.9%) patients with HGS died of the disease and none died among LGS. Descriptive analysis revealed a statistically significant association between death and HGS (p=0.024), sarcomas with nuclear grade 3 (p=0.029), mitotic index > 60 (p=0.016) and presence of lymphovascular invasion (p=0.028). More than 80% of the patients with recurrence were diagnosed with HGS. Median overall survival time was 70 months. The2, 5- and 10-year survival rates were 65%, 58% and 43% respectively. No statistically significant association was observed between survival times and histologic types of sarcoma (p=0.204) but stage 1 and 2 had a better survival compared to stage 3 and 4. Over expression of P53 was only found in 4 cases of CS; and complete membranous staining for Her-2 was also only observed in CS tumors (n=6). ER positive staining was found in all MAS and ESS tumors only. C-kit positive expression was observed in 8 cases, 7 of which were from HGS group.

Conclusion: This study reconfirms HGS being aggressive tumors with short survival rate. Greater mitotic index and nuclear grade, tumor cell type and vascular invasion are important prognostic indicators of survival

Author Biographies

Abdul Mohsen Al Kushi

College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Ahmad Omair

Dept. of pathology, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Haitham Arabi

Dept. of Pathology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

Motasim Badri

Department of Epidemiology & Biostatistics, College of Public Health & Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Published
2019-06-15