Clinicopathological Predictors of Recurrence in Uterine Sarcomas—A Narrative Review

TL;DR

This review explores factors that predict recurrence in uterine sarcomas to improve patient care and outcomes.

Contribution

The paper provides a narrative review of clinicopathological and molecular predictors of recurrence in specific uterine sarcoma subtypes.

Findings

Stage, grade, tumor size, and molecular biomarkers are key predictors of recurrence in uterine sarcomas.

Next-generation sequencing helps identify women at higher risk of recurrence and poor prognosis.

Contradictory results in existing data highlight the need for further research on risk stratification.

Abstract

Background: Sarcomas are a rare and biologically diverse group of malignant tumors that originate from mesenchymal tissues. They are characterized by a broad range of histopathological subtypes, varying clinical courses, and differing responses to treatment. This study seeks to clarify the clinicopathological and molecular predictors of recurrence in leiomyosarcomas, carcinosarcomas, and endometrial stromal sarcomas to enhance our understanding, thereby improving clinical knowledge, consultation practices, and the overall benefit for patients. Methods: A literature search was conducted utilizing PubMed/MEDLINE, Embase, Cochrane Library, and Scopus to execute a comprehensive structured narrative review of articles published up to 31 March 2025. Results: We summarize existing evidence on the clinical, histological, and molecular predictors of recurrence and poor prognosis for leiomyosarcomas, carcinosarcomas, and endometrial stromal sarcomas. While the stage, grade, tumor size, and novel molecular biomarkers are crucial high-risk parameters that have been associated with recurrence, existing data demonstrate contradictory results, indicating the need for further research. Conclusions: Recent advancements in next-generation sequencing have facilitated the identification of women at increased risk of recurrence, poor disease-free survival, and overall adverse prognosis. Stratifying this risk requires a comprehensive understanding of the clinical, histological, and molecular risk factors involved. Understanding these underlying factors is essential for effectively addressing the initial consultation, guiding management, and—considering the novel treatment modalities—individualizing the care provided to the affected women.

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