Clinicopathologic characteristics and oncologic outcomes in adenosarcoma of gynecologic sites

Abstract

<h3>Objectives:</h3> Adenosarcoma is a rare neoplasm of which there is limited data available in the literature. The objective of this study is to examine clinicopathologic characteristics and oncologic outcomes of patients diagnosed with adenosarcoma. In addition, this study aims to evaluate fertility preservation as a practical management option in early-stage disease. <h3>Methods:</h3> A retrospective review was performed of 31 patients treated for uterine, ovarian, or cervical adenosarcoma at our institution between 1/2000-3/2020. <h3>Results:</h3> Median age was 51 years (IQR: 41-68). Median follow-up time was 26 months (IQR:13-83). Primary sites included uterus (n=23, 74.2%), cervix (n=7, 22.6%), and ovary (n=1, 3.2%). Stage at diagnosis was as follows: IA (n=18, 58.1%), IB (n=7, 22.6%), IC (n=3, 9.7%), IIIA (n=1, 3.2%), IIIC (n=1, 3.2%), and IVB (n=1, 3.2%). Surgical management primarily consisted of total hysterectomy±bilateral salpingo-oopherectomy±lymph node dissection. Fifteen (48.1%) patients underwent lymph node dissection; no patients had positive nodes. Ovaries were preserved in 6 (19.4%). In terms of adjuvant therapy, 22 (71.0%) patients received none, 4 (12.9%) received chemotherapy, 1 (3.2%) received chemoradiation, and 3 (9.7%) received hormonal therapy. Seven patients had recurrences, of which 1 was vaginal, 2 were regional, and 4 were distant. Of these 7 patients, 4 were patients with early-stage disease. Sarcomatous overgrowth (p=0.04), high grade histology (p=0.002), and greater degree of myometrial invasion (p=0.001) were associated with higher rate of recurrence. Adjuvant therapy was not associated with decreased rate of recurrence. None of the 6 patients with ovarian preservation had recurrences. At last follow up, 21 patients (67.7%) had no evidence of disease, 7 (22.6%) were deceased due to disease, and 3 (9.7%) were deceased due to non-related reasons. <h3>Conclusions:</h3> Early stage adenosarcoma appears to have a relatively good prognosis, especially in the absence of risk factors, such as sarcomatous overgrowth, high grade histology, and myometrial invasion. Lymphadenectomy and chemotherapy may play a limited role in this patient cohort. Further, ovarian preservation appears to be a feasible management option with non-inferior outcomes for premenopausal women with early stage disease.