Background/Objectives: Uterine adenosarcoma is a rare uterine malignancy with limited evidence on prognostic factors and long-term outcomes. We aimed to evaluate clinicopathological characteristics, treatment patterns, oncologic outcomes, and prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in patients with uterine adenosarcoma. Methods: This multicenter retrospective cohort study included 43 patients with histopathologically confirmed uterine adenosarcoma who underwent primary surgery at seven tertiary referral centers in Türkiye between 2016 and 2026. Clinicopathological features, treatment modalities, recurrence patterns, and survival outcomes were assessed. Survival was analyzed using Kaplan–Meier and log-rank methods, and multivariable Cox proportional hazards regression was performed to identify independent prognostic factors. Results: The mean age at diagnosis was 59.1 ± 10.8 years, and 83.7% of patients were postmenopausal. Pelvic pain (62.8%) and abnormal uterine bleeding (60.5%) were the most common presenting symptoms. Most patients (79.1%) underwent laparotomy, and 79.1% had stage I disease. Sarcomatous overgrowth (SO) was present in 44.1% and lymphovascular space invasion (LVSI) in 18.6%. During a median follow-up of 72 months, 34.9% experienced recurrence, most commonly in the pelvis. The five-year DFS and OS rates were 59.9% and 80.4%, respectively. SO was independently associated with DFS (HR 4.41, 95% CI 1.21–16.08; p = 0.025) and OS (HR 10.23, 95% CI 1.16–89.80; p = 0.036), while LVSI was independently associated with OS (HR 11.17, 95% CI 1.34–93.14; p = 0.026). Conclusions: Uterine adenosarcoma showed favorable long-term survival but substantial recurrence risk. SO and LVSI may have potential prognostic relevance and could contribute to postoperative risk assessment and individualized follow-up.

Background: To compare outcomes between older (≥ 70 years) and younger (< 70 years) patients with surgically treated endometrial cancer, evaluating the Prognostic Nutritional Index (PNI), Systemic Immune-Inflammation Index (SII), and Age-Adjusted Charlson Comorbidity Index (ACCI). Methods: This retrospective cohort study included 319 patients who underwent surgery at a tertiary center (2014–2024). Demographics, pathology, treatment, and outcomes were analyzed. Perioperative morbidity was graded (Clavien–Dindo). Frailty (ACCI), PNI, and SII were assessed. Overall survival and disease-specific survival were analyzed in parallel; Kaplan–Meier analyses were performed overall and stratified by stage and histology. Major morbidity was analyzed with multivariable logistic regression. Results: Of 319 patients, 93 (29.2%) were aged ≥ 70 years. Older patients more frequently exhibited high-grade histology, advanced stage, ASA III–IV status, high ACCI, and low PNI. Admissions to the intensive care unit were higher in older patients, but major morbidity (4.3% vs. 3.5%; p = 0.60) and 30-day mortality (1.1% vs. 0.9%; p = 0.60) were comparable between groups. Low PNI demonstrated moderate discriminatory ability for major complications. In multivariable analysis, low PNI (odds ratio 5.78; p = 0.012) and ASA III–IV (odds ratio 3.89; p = 0.047) were independently associated with major morbidity, whereas age ≥ 70 was not. For overall survival, higher PNI remained protective (hazard ratio 0.48 per 5-point increase; p < 0.001) and ASA III–IV predicted worse outcomes (hazard ratio 3.80; p = 0.002); however, chronological age was not an independent predictor. Conclusion: Older age is associated with more aggressive tumor biology but not with higher rates of major complications. PNI and ASA class are independent predictors of major morbidity and survival and should be integrated into perioperative risk stratification rather than using chronological age alone.