Urological sarcomas are rare. We describe a continued single institutional experience during 25 years.
Materials and Methods:
The records from July 1977 to July 2003 were reviewed of all patients at our institution with sarcoma arising in the urinary tract or male genital system who were 16 years or older at diagnosis.
The primary tumor site in 131 patients was the bladder in 20, the kidney in 26, paratesticular in 57, the prostate in 21 and other in 7. Median followup was 4.0 years. The most common histological subtypes were leiomyosarcoma in 29% of cases and liposarcoma in 26%. Median tumor size was 7 cm and 78% of lesions were high grade. Of the patients 28 (21%) presented with metastatic disease and their median survival was 1.4 years compared to 10.7 years in patients without metastatic disease (p <0.0001). Disease specific survival was 56% and 42% at 5 and 10 years, respectively and median survival was 7.6 years. On univariate analysis unfavorable prognostic variables for disease specific survival were metastasis at presentation, high tumor grade, a lack of leiomyosarcoma and liposarcoma histological subtypes, prostate sarcoma and large tumor size, incomplete surgical resection and positive surgical margin. Patient sex, age and surgical margin status were not significant predictors. On multivariate analysis 2 variables remained significant predictors of disease specific survival, including tumor size (HR 1.1, 95% CI 1.02 to 1.17) and absent metastasis at diagnosis (HR 4.9, 95% CI 1.4 to 17.2).
Predictors of disease specific survival include local disease at presentation, complete tumor resection and tumor grade, size, location and histological subtype. With adequate surgical treatment most patients who presented with primary disease and underwent complete surgical resection achieved prolonged disease specific survival.
- 1 : Cancer statistics, 2005. CA Cancer J Clin2005; 55: 10. Google Scholar
- 2 : Primary adult soft tissue sarcoma: time-dependent influence of prognostic variables. J Clin Oncol2002; 20: 4344. Google Scholar
- 3 : Adult urological sarcoma. J Urol1992; 147: 1032. Abstract, Google Scholar
- 4 : Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg2002; 235: 424. Google Scholar
- 5 : Sarcomas of the kidney. J Urol1984; 132: 13. Abstract, Google Scholar
- 6 : Adult prostate sarcoma: the M. D. Anderson Cancer Center experience. J Urol2001; 166: 521. Link, Google Scholar
- 7 : Primary renal sarcoma in adults. Cancer1993; 71: 804. Google Scholar
- 8 : Sarcoma and carcinosarcoma of the bladder in adults. J Urol1985; 133: 29. Link, Google Scholar
- 9 : Adult spermatic cord sarcomas: management and results. Ann Surg Oncol2003; 10: 669. Google Scholar
- 10 : Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg1998; 228: 355. Google Scholar
- 11 : Prognostic factors predicting survival in the treatment of retroperitoneal sarcoma. Eur J Surg Oncol2000; 26: 552. Google Scholar
- 12 : Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg2005; 92: 246. Google Scholar
- 13 : Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol2002; 20: 791. Google Scholar
- 14 : Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys1994; 29: 1005. Google Scholar
- 15 : Soft-tissue sarcomas in adults. N Engl J Med2005; 353: 701. Google Scholar
- 16 : Favorable long-term outcome in adult genitourinary low-grade sarcoma. Urology2000; 56: 373. Google Scholar
- 17 : Adult paratesticular tumours. BJU Int2002; 90: 707. Google Scholar
Departments of Urology, Surgery and Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York