CLINICOPATHOLOGICAL CHARACTERISTICS, MANAGEMENT OUTCOMES, AND INSTITUTIONAL PREVALENCE OF UTERINE SARCOMAS AMONG DIFFERENT GYNECOLOGICAL PATHOLOGIES: A 5-YEAR RETROSPECTIVE COHORT STUDY (2021–2025) AT KING SAUD MEDICAL CITY

Abstract

Background/Aim

Uterine sarcomas are rare, highly aggressive malignancies with poor prognoses. This study aims to evaluate the clinical features, surgical outcomes, and treatment timelines of uterine carcinosarcoma and leiomyosarcoma (LMS), comparing their profiles against common baseline conditions and established regional Saudi Arabian benchmarks to improve preoperative risk stratification.

Patients and Methods: This retrospective cohort study was conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, spanning a five-year period from 2021 to 2025. The study cohort included 12 uterine sarcoma cases (8 carcinosarcomas, 4 LMS) compared with baseline reference tracks of 91 endometrial adenocarcinomas and 282 benign uterine fibroids treated at the institution. Statistical comparisons were performed using non-parametric analytics to evaluate demographic profiles, macroscopic tumor dimensions, staging distributions, and postoperative resource utilization.

Results: A significant age gap (p = 0.048) was observed between the older carcinosarcoma cohort (68.50 ± 8.94 years) and the younger LMS group (48.50  ± 19.38 years). Macroscopically, 100% of LMS cases presented as massive pelvic lesions exceeding 10 cm (p = 0.044), which contributed to a poor preoperative biopsy detection rate of 50% and a prolonged mean operative time of 263.5 ± 71.9 minutes (p = 0.023). Advanced metastatic disease (FIGO Stage IV) was present in 50%$ of the entire cohort at presentation. Genetic screening revealed a 25% BRCA/Lynch syndrome positivity rate in the carcinosarcoma group. Postoperatively, the 30-day readmission rate reached 41.7%, driven by disease progression or complications. Longitudinal tracking revealed an overall mortality rate of 41.7% (50% for LMS, 37.5% for carcinosarcoma).

Conclusion: Uterine sarcomas present a critical diagnostic challenge, frequently appearing as incidental findings within a vast 70-to-1 benign smooth muscle background. The distinct clinical differences in age, tumor mass, and staging highlight the urgent need for multi-center national registries and improved preoperative imaging to optimize surgical care and patient survival in Saudi Arabia.