Hysterectomy-corrected, age-specific incidence and survival of uterine sarcomas by histotype, race and ethnicity in the United States, 2000-2019.

Authors

Dhruva Dave, Rebecca C Arend, Charles A Leath, Michael D Toboni, Nicolas Wentzensen, Martin Köbel, Britt K Erickson, Akemi T Wijayabahu, Megan A Clarke

Published in

American journal of obstetrics and gynecology. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Uterine sarcomas are rare but aggressive mesenchymal malignancies of the uterus, characterized by diverse histotypes and poor survival. However, little is known about the epidemiology and clinical characteristics of uterine sarcoma histotypes at the population level.
To evaluate hysterectomy-corrected, age-specific incidence rates and five-year relative survival by histologic subtype, stage at diagnosis, and race/ethnicity among U.S. individuals aged ≥20 years diagnosed with uterine sarcoma in the SEER 22 registries from 2000-2019.
This retrospective population-based study included microscopically confirmed uterine sarcoma cases registered in the SEER 22 database. Hysterectomy-corrected, age-specific incidence rates were calculated by histotype, stage at diagnosis, and race/ethnicity. Five-year relative survival was estimated using the Ederer II method in SEER*Stat software (version 9.0.42).
A total of 14,801 individuals aged ≥20 years diagnosed with uterine sarcoma were included. Leiomyosarcoma (LMS) were most common comprising 53.3% of the total cases (n=7883), endometrial stromal sarcoma (ESS) accounted for 26.7% of cases (n=3948), Adenosarcoma for 12.7% (n=1884), sarcoma not otherwise specified (NOS) for 5.7% (n=837), and undifferentiated sarcoma for 1.7% of cases (n=249). Incidence rates of uterine sarcomas increased until ages 50-54 and plateaued thereafter other than among Non-Hispanic Black (NHB) individuals, where incidence continued to increase until ages 65-69 years. LMS demonstrated the highest hysterectomy-corrected incidence (0.6 per 100,000), followed by ESS (0.3 per 100,000) and Adenosarcoma (0.1 per 100,000). NHB individuals had the highest incidence of uterine sarcomas across all histotypes. Overall, NHB individuals were more likely to be diagnosed with distant diseases compared with other groups. Among all individuals, five-year relative survival was 42.3% (95% CI: 41-43.5) for LMS, 70.2% (68.5-71.8) for ESS, and 78.3% (75.7-80.6) for Adenosarcoma. When categorized by stage at diagnosis, relative survival for localized disease ranged from 62% to 85% in all histotypes, vs. 13.5% to 34.7% for distant metastatic disease. Survival was lowest among NHB individuals, 41.9%, versus 55.4 % in Non-Hispanic White (NHW) individuals, across all histotypes and stage at diagnosis.
Uterine sarcomas exhibit pronounced heterogeneity, comprising distinct histotypes that demonstrate variable incidence patterns and survival trajectories. LMS had the highest incidence and worse survival compared with ESS and Adenosarcoma. NHB individuals had the highest incidence rates for all histotypes and were more likely to have advanced disease and worse survival compared with other groups. Future studies are required to evaluate underlying risk factors, early detection strategies, and response to therapy by histotype, with a particular focus on addressing disparities in NHB individuals.

PMID:
42951232
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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