Elsevier

Gynecologic Oncology

Volume 93, Issue 1, April 2004, Pages 204-208
Gynecologic Oncology

Surveillance, Epidemiology, and End Results analysis of 2677 cases of uterine sarcoma 1989–1999

https://doi.org/10.1016/j.ygyno.2003.12.029Get rights and content

Abstract

Objective. To determine the association of race with incidence, histology, treatment, and survival in women with uterine sarcoma during the period 1989–1999.

Methods. Uterine sarcomas were defined as leiomyosarcoma, carcinosarcoma, high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified (NOS). We used cases from Surveillance, Epidemiology, and End Results (SEER) program to compare uterine sarcoma among women >35 years of age. Using data from 1989 to 1999, we compared race-specific age-adjusted incidences, histological distributions, extent of disease at diagnosis, and race-specific survival.

Results. During the period of 1989–1999, 2677 women were diagnosed with uterine sarcoma, 2098 (78%) of whom were white and 420 (16%) of whom were black, and 159 (6%) of whom were of other races. The overall age-adjusted incidence for blacks was twice that of whites and more than twice that of women of other races (7/105 vs. 3.6/105 vs. 2.7/105, P < 0.0001). Racial differences in the incidence of uterine sarcoma existed for leiomyosarcoma (1.51/105 for blacks vs. 0.91/105 for whites, and 0.89 for women of other races, P < 0.01) and carcinosarcoma (4.3/105 for blacks, vs. 1.7/105 for whites, and 0.99 for women of other races, P < 0.001), but not for other histological types. Blacks with stage II disease were less likely to receive radiation in addition to surgery compared to whites (33% vs. 54%, P < 0.05). Five-year relative survival of patients with disease beyond the uterus was significantly longer for those that received radiation and surgery compared to those that received surgery alone. There were no racial differences in survival for women that received similar therapy.

Conclusions. Adjuvant therapy improved survival for women with stage II–IV disease. Survival of black and white patients who received comparable treatment was similar.

Introduction

Uterine sarcomas are rare tumors of the uterus and in previous reports have been estimated to comprise 4–9% of all invasive uterine cancers [1], [2]. The literature describing the epidemiology of these tumors is sparse; with the most comprehensive reports describing these tumors published in 1986 and 1995. In 1986, Harlow et al. [3] noted an excess incidence of leiomyosarcoma and mixed mesodermal sarcoma for blacks compared with whites; however, little information was available at that time regarding survival, stage distribution, and treatment. The subsequent report by Platz and Benda [4] acknowledged leiomyosarcoma and mixed mullerian tumors/carcinosarcoma as the most common of the sarcomas and noted that blacks with carcinosarcoma were less likely to be diagnosed with localized disease compared to whites. Given the observed difference in incidence between blacks and whites, we analyzed data from the network of population-based cancer registries that make up the SEER program of the National Cancer Institute to determine the demographic characteristics, histological distribution, patterns of treatment, and survival in women with uterine sarcoma.

Section snippets

Methods

The inclusion criteria included women over age 35 with invasive malignancies primary to the uterus, and histologically confirmed as leiomyosarcoma, carcinosarcoma (mixed mullerian or mixed mesodermal sarcoma), high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified using the National Cancer Institute's population-based Surveillance, Epidemiology and End Results (SEER) program International Classification of Disease (ICD-0-2) and ICD-0-3 coding. Due to

Incidence

During the study period of 1989–1999, uterine sarcomas represented 8% of primary uterine malignancies; 2098 were white, 420 black, and 159 were of other races. Statistical comparison of mean age at the time of diagnosis for whites vs. blacks and whites vs. women of other races revealed that white women were significantly older at the time of diagnosis (64.2) compared to blacks (62.7, P < 0.05) and women of other races (58.5, P < 0.01). The age-adjusted incidence rate of uterine sarcoma in black

Discussion

Our results confirm that blacks continue to be at greater risk than whites for the occurrence of uterine leiomyosarcoma and carcinosarcoma. While our report is agreement with that of Harlow et al., it differs with the 1995 report by Platz and Benda who reported an excess incidence of leiomyosarcoma for blacks, but not for carcinosarcoma. The reasons for the differences in findings may reflect our combining carcinosarcoma and mixed mullerian tumors into one group as these tumors are currently

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