Clinicopathological Predictors of Recurrence in Uterine Sarcomas – A Narrative Review

Background: Sarcomas are a rare and biologically diverse group of malignant tumors that originate from mesenchymal tissues. They are characterized by a broad range of histopathological subtypes, varying clinical courses, and differing responses to treatment. This study seeks to clarify the clinicopathological and molecular predictors of recurrence in leiomyosarcomas, carcinosarcomas, and endometrial stromal sarcomas to enhance our understanding, thereby improving clinical knowledge, consultation practices, and the overall patient benefit. Methods: A literature search was conducted utilizing PubMed/MEDLINE, Embase, Cochrane Library, and Scopus to execute a comprehensive structured narrative review of articles published until 31 March 2025 Results: We summarized the current evidence on clinical, histological and molecular predictors of recurrence and poor prognosis of leiomyosarcomas, carcinosarcomas and endometrial stromal sarcomas. The stage, the grade and the tumour size, as well as, novel molecular biomarkers constitute crucial high risk parameters that have been associated with recurrence but data, so far, demonstrate contradictory results with the need of further research deemed necessary. Conclusions: Recent advancements in next-generation sequencing have facilitated the identification of women at increased risk of recurrence, poor disease-free survival, and overall adverse prognosis. The stratification of this risk requires a comprehensive understanding of the clinical, histological, and molecular risk factors involved. An understanding of those underlying factors is essential for effectively addressing the initial consultation, guiding management, and, considering the novel treatment modalities, individualizing the care for affected women.