Metastatic Uterine Sarcomas: A Retrospective Analysis on Clinical Outcomes and Biology.

Introduction Metastatic uterine sarcomas are aggressive malignancies with poor outcomes and a scarcity of real-world data. Methods This retrospective study collected data from patients treated over eight years, from January 2018 to December 2025. The included patients had histopathologically confirmed sarcoma arising from the uterus who were deemed unresectable or were metastatic and treated with palliative intent. Results Twenty-eight patients were included in the final analysis, and 23 received first-line treatment. High-grade endometrial stromal sarcomas (HG-ESS) and uterine leiomyosarcomas (ULMS) were the most common histologies. The most common metastatic sites were the pelvis/peritoneum (60.7%) and lungs (57.1%). Anthracycline-based regimens, with or without ifosfamide and gemcitabine, plus docetaxel, were the most common first-line regimens. Disease control rate (DCR) was 13/23 (56.52%). Overall survival (OS) for the whole cohort was five months (95% confidence interval (CI): 0.8-9.2 months). By histologic subtype, HG-ESS had the shortest median OS at four months (95% CI: 1.84-6.12 months), whereas ULMS had the best prognosis, with a median OS of 11 months (95% CI: 2.35-19.65 months). Patients on best supportive care had a median OS of one month, whereas those receiving any treatment had a median OS of 10 months (95% CI: 5.9-14 months) (p<0.001). Patients with a maximum tumor dimension of less than 10 cm had significantly better OS than those with more than 10 cm (10 months (95% CI: 4.8-15.2 months) versus five months (95% CI: 2.6-7.4 months); p=0.031). Conclusion The prognosis of metastatic uterine sarcomas remains dismal. Further studies are needed to identify the optimal treatment and sequencing while incorporating molecular classification, especially for HG-ESS.