Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study

Objectives: To determine the preoperative clinical characteristics associated with uterine sarcoma in patients with uterine mass. Study design: We retrospectively reviewed medical records of patients who presented with uterine mass undergoing surgery at Ramathibodi Hospital, with a pathologically confirmed diagnosis, from April 1, 2000 to October 31, 2019. The cases are patients with uterine sarcoma, whereas the controls are patients with leiomyoma diagnosed in the same year, with a proportion of 1 case per 4 controls. The association between preoperative clinical characteristics and uterine sarcoma were analyzed. Results: There were 18,218 patients with uterine mass undergoing surgery at Ramathibodi Hospital during the study period. Uterine sarcoma was diagnosed in 68 patients. Thus, the incidence of uterine sarcoma was 0.37%. Following multivariate regression analysis, the following factors seemed to be independently associated with increased risk of uterine sarcoma. Patients with uterine mass, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, recognition of rapid growing mass, and with single uterine mass identified by ultrasonography were more likely to be diagnosed with uterine sarcoma with adjusted odds ratio (95% confidence interval) of 3.30 (1.29–8.43), 8.57 (2.38–30.82), 35.35 (2.94–425.13), 3.39 (1.40–8.23), 4.50 (1.78–11.36), 6.91 (2.08–22.91) and 4.70 (1.91–11.60), respectively. Conclusions: Clinical characteristics, ie, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, mass with rapid growth, or single uterine nodule identified by ultrasonography were considered the independently strong association with uterine sarcoma in women who presented with uterine mass.