title: Outcome and prognosis in uterine sarcoma and malignant mixed Mullerian tumor.
abstract: There is low evidence regarding the optimal treatment in patients with uterine sarcomas and malignant mixed Mullerian tumors (MMMTs). This study provides an overview of experience at our center with patients diagnosed with uterine sarcoma and MMMT, in relation to the clinical management and outcome.
  
  
  
  The medical records for 143 patients with low-grade endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and high-grade (undifferentiated) endometrial sarcoma (UES) and MMMT were reviewed. All available clinical and pathological data were collected and analyzed. Putative prognostic factors were entered into a multivariate analysis using a Cox proportional hazards ratio model, and survival data were calculated.
  
  
  
  The 5-year overall survival rates were significantly different between patients with ESS, LMS, and UES and MMMT (86 vs. 40 vs. 57 vs. 45 %; P < 0.001). The multivariate analysis showed that the patients' age, higher FIGO stage (III-IV), a history of smoking, prior pelvic radiation, diabetes, and residual tumor after surgery were associated with a poorer overall survival. Histological subtypes of LMS (HR 4.68; 95 % CI 1.35-16.17), UES (HR 1.21; 95 % CI 0.26-5.77) and MMMT (HR 1.63; 95 % CI 0.42-6.43) were also associated with a poorer overall survival than ESS (P = 0.008). Adjuvant therapies showed no associations with overall survival.
  
  
  
  Adjuvant therapy has so far not shown any overall survival benefit, and the focus is therefore on primary surgery. In future studies, the entities should be investigated separately in relation to prognostic factors and effective therapeutic management.
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany. stefanie.burghaus@uk-erlangen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Burghaus
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Halmen
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Gass
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Grit
authors.initials: G
authors.lastname: Mehlhorn
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Schrauder
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Renner
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hein
authors.affiliation: Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.|ALB FILS KLINKEN GmbH, Goeppingen, Germany.
authors.forename: Falk C
authors.initials: FC
authors.lastname: Thiel
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D036821:Endometrial Stromal Tumors / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D018200:Mixed Tumor, Mullerian / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012509:Sarcoma / Q000473:pathology; D018203:Sarcoma, Endometrial Stromal / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
keywords: Endometrial stromal sarcoma; Leiomyosarcoma; Malignant mixed Mullerian tumor; Outcome; Undifferentiated endometrial sarcoma; Uterine sarcoma