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Carroll A, Ramirez PT, Westin SN, Soliman PT, Munsell MF, Nick AM, Schmeler KM, Klopp AH, Fleming ND. Uterine adenosarcoma: an analysis on management, outcomes, and risk factors for recurrence. Gynecol Oncol. 2014;135(3):455-61. PMID 25449308

One-paragraph summary

Retrospective review of patients evaluated and treated for uterine adenosarcoma at MD Anderson from July 1982 through December 2011. 100 patients identified, 74 met inclusion. On multivariate analysis, sarcomatous overgrowth and LVSI predicted worse PFS and OS. Median PFS and OS 29.4 and 55.4 months with SO versus 105.9 and 112.4 months without (PFS HR 2.58, 95% CI 1.37–4.84, p=0.003; OS HR 2.45, 1.26–4.76, p=0.008). Stage I recurrence 17/22 (77%) with SO versus 8/37 (22%) without (p<0.001). Among stage I with SO, adjuvant therapy associated with longer PFS (46.7 vs 29.4 months, p=0.28) and OS (97.3 vs 55.4 months, p=0.18) — not statistically significant. No optimal treatment strategy for SO identified.

Key findings

  • SO HR for PFS 2.58 (1.37–4.84) and OS 2.45 (1.26–4.76) — the load-bearing multivariable estimate in the field.
  • Stage I is not homogeneous: 77% vs 22% recurrence by SO.
  • The only comparative adjuvant signal in adenosarcoma, and it is not significant.

Limitations

  • Single institution, 30-year span, adjuvant regimens not standardised.
  • 74 of 100 included: exclusion criteria matter and are not fully visible in the abstract.
  • Adjuvant analysis in stage I SO is a small subset (22 patients) and is compatible with no effect.

Why it matters

This is the paper later reviews quote for the SO survival split and the paper later guidelines use when they say adjuvant therapy is “not established” but “can be considered.” It is also the design sketch for an adenosarcoma-specific study that has not produced a reported outcome; an older mixed-histology phase 3 registration exists (NCT00162721) but has unknown status and no posted results.

Cited by wiki pages

  • overview
  • sarcomatous-overgrowth
  • staging-and-prognostic-factors
  • adjuvant-and-systemic-therapy
  • recurrence-and-surveillance
  • guidelines
  • clinical-trials-landscape
  • red-flags-and-safety-concerns
  • patient-experience-and-advocacy