Gynecologic sarcoma incidence, survival, and initial treatment trends: a retrospective analysis of a US subpopulation. BMC Women’s Health



Incidence trends

The overall age-adjusted incidence of GS increased from 2.38 per 100,000 in 1975 to 3.41 per 100,000 by 2015, with an AAPC of 1.0 (P.< 0.05), AAPC is 1.3 (P.< 0.05) over the last decade (2006–2015) (Fig. 1A and Supplementary File 1: Table S1). There was a significant increase in the incidence of GS in patients aged 20-54 and ≥55 years. Overall her AAPC for patients aged 20–54 years over the past 10 years was 1.0 and 2.0 (P.< 0.05), respectively 0.9 and 1.9 (P.< 0.05), respectively, patients aged 55 years and older (Figure 1A and Supplemental File 1: Table S1). Black populations had relatively higher incidence and an increasing trend compared with white and other racial populations (Fig. 1B and Supplementary File 1: Table S1). Analysis of different primary sites reveals an increase in the incidence of corporal and uterine GS from 2.11 to 2.68 per 100,000 population from 1975 to 2015, with a AAPC of 0.8 for his from 1975 to 2015. became(P.< 0.05) and 1.5 for 2006-2015 (P.< 0.05). Incidence of ovarian GS (0.14–0.53 per 100,000; AAPC 2.1; P.< 0.05) and GS for other sites (0.07–0.14 per 100,000, AAPC 1.2, P.< 0.05) also showed an increasing trend. In contrast, the incidence of cervical GS showed no apparent change (0.06 to 0.06 per 100,000; AAPC 0.9, P.> 0.05) (Figure 1C and Supplementary File 1: Table S1). Notably, the increasing trend in ovarian GS has disappeared over the past decade (AAPC from 2006 to 2015 was 0.2, P.> 0.05). The incidence of GS at various stages also showed an increasing trend, which was more pronounced in regional stage patients. Although the incidence of unstaged GS showed a decreasing trend (AAPC-2.7, P.> 0.05) (Figure 1D and Supplementary File 1: Table S1).

Figure 1
Figure 1

Incidence of gynecologic sarcoma. Ah Overall, by age group, B. by race, Ha By primary tumor site, D. Surveillance, epidemiology, by final outcome stage

In addition, trend analysis by primary site and stage was performed. As shown in Supplementary File 2: Figure S1 and Supplemental File 3: Table S2, there was a significant increase in incidence in GS located in the body and uterus, ovaries and other sites in regional and distant stages. APC details for different time periods are summarized in Supplementary File 1: Table S1 and Supplementary File 3: Table S2.

The incidence of body- and uterine- and ovarian-located GS increased with age, peaking at 70–74 years and then decreasing. However, the incidence of GS in the cervix and other sites did not change significantly with age (Additional File 4: Figure S2).

Mortality based on prevalence and incidence

As shown in Figure 2A, the 20-year time-limited prevalence of corporal and uterine GS increased significantly from 1996 to 2015, from 1.85 to 17.45 per 100,000 population. and GS of other sites increased slowly. In addition, an increase in annual prevalence of corporal and uterine GS was also observed, increasing from 1.85 to 2.27 per 100,000 population from 1996 to 2015. .

Figure 2
Figure 2

Prevalence of gynecologic sarcoma. Ah 20-year limited prevalence by primary tumor site, B. Annual prevalence by primary tumor site

Mortality based on incidence of corporal and uterine GS (AAPC 1.2, P.<0.05) and other site GS (AAPC 3.3,P.<0.05) showed an increasing trend. Mortality trends based on the incidence of cervical and ovarian GS showed no significant change over the past decade (Additional File 5: Figure S3 and Additional File 6: Table S3).

stage distribution

In all GS cases, the local stage accounted for 41.4%, followed by the distant stage (33.1%) and the regional stage (20.3%). Approximately 5.2% of GS cases were of unknown stage. GS with different primary tumor sites had different stage distributions. GS located in the cervix, corpus, uterus, and other sites showed a higher proportion of focal stages. In contrast, the most common stage of ovarian GS was the distant stage, up to 73.3% (Fig. 3).

Figure 3
Figure 3

Stage Distribution of Gynecologic Sarcoma

Cancer-specific survival rate

Overall, the estimated 3-year CSS rates for cervix, uterine corpus and uterus, ovary, and other site GS were 61.2%, 52.6%, 31.7%, and 58.7%, respectively. Additionally, the estimated 5-year CSS rates were 54.4%, 46.0%, 24.2%, and 53.0%, respectively. In local and distant stage cases, GS at other sites had better 3- and 5-year CSS rates compared with other GSs. In local stage cases, cervical GS showed the highest 3-year and 5-year CSS rates. Details of the 3- and 5-year CSS rates are shown in Figure 4.

Figure 4
Figure 4

Cancer-specific survival for gynecologic sarcoma. Ah Cancer-specific 3-year survival rate by primary tumor site, B. Cancer-specific 5-year survival rate by primary tumor site

From 1975 to 2015, cervical and ovarian GS improved 3- and 5-year CSS rates, with improvements being more pronounced at the local stage (Figure 5A,C,E,G). Although there was no apparent improvement in overall 3- and 5-year CSS rates for corporal and uterine GS from 1975 to 2015, rates for all cases with known stage all increased significantly. (Figure 5B,F). The 3- and 5-year CSS rates of other site GS decreased mainly due to the reduction of focal stage (Fig. 5D,H).

Figure 5
Figure 5

Cancer-specific survival trends. AhD. Cancer-specific 3-year survival trends by primary tumor site, eH. Cancer-specific 5-year survival trends by primary tumor site

Initial treatment and tendencies

Overall, approximately 87.7% of GS cases underwent surgery, and approximately 39.9% of cases underwent surgery as the sole modality during first-course treatment. The proportion of cases receiving chemotherapy and radiotherapy was 38.2% and 25.7%. Treatment patterns for each primary site were generally consistent with the overall population, except for a much higher proportion of chemotherapy and a lower proportion of radiotherapy in ovarian GS cases. Overall, approximately 6.4% of cases were untreated, more prominent in cases of cervical GS (11.8%). Details of treatment patterns are summarized in Table 1.

Table 1 Initial Treatment and Trends in Gynecologic Sarcoma

Changes in treatment patterns for each primary site from 1975 to 2015 are also listed in Table 1, and significant changes were observed. In general, the proportion of cases receiving surgery and radiation decreased, but the proportion of corporal and uterine GS cases receiving surgery increased. The rate of receiving chemotherapy is increasing year by year. In addition, there was a decrease in the proportion receiving only one treatment modality as first-line treatment, mainly due to a reduction in surgery alone. In contrast, the proportion receiving two or more treatments increased significantly.


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