Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group

• Published in: International journal of clinical oncology Vol. 21; no. 1; pp. 168 - 176
• Main Authors: Harano, Kenichi, Hirakawa, Akihiro, Yunokawa, Mayu, Nakamura, Toshiaki, Satoh, Toyomi, Nishikawa, Tadaaki, Aoki, Daisuke, Ito, Kimihiko, Ito, Kiyoshi, Nakanishi, Toru, Susumu, Nobuyuki, Takehara, Kazuhiro, Watanabe, Yoh, Watari, Hidemichi, Saito, Toshiaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-02-2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Blood Vessels - pathology; CA-125 Antigen - blood; Cancer Research; Carcinosarcoma - blood; Carcinosarcoma - pathology; Carcinosarcoma - therapy; Chemotherapy, Adjuvant; Disease-Free Survival; Female; Humans; Japan; Lymph Node Excision; Lymph Nodes - pathology; Medicine; Medicine & Public Health; Middle Aged; Muscle Neoplasms - pathology; Myometrium - pathology; Neoplasm Invasiveness; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neoplasm, Residual; Oncology; Original Article; Pelvis; Retrospective Studies; Surgical Oncology; Survival Rate; Treatment Outcome; Tumor Burden; Uterine Neoplasms - blood; Uterine Neoplasms - pathology; Uterine Neoplasms - therapy; Japan; Pelvic lymph node; Prognostic factor; Uterine carcinosarcoma; Lymphadenectomy
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-015-0859-7

Background
Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known.
Methods
We performed a multi-institutional, retrospective study of women with stage I–IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information.
Results
A total of 486 patients (median age 65 years) were identified—224 (46 %) were stage I, 32 (7 %) were stage II, 139 (28 %) were stage III, and 91 (19 %) were stage IV. Among them, 277 (57 %) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 % confidence interval (CI) 15.7–27.2], and median overall survival (OS) was 72.0 months (95 % CI 43.0–not reached). In total, 454 (94 %) patients received adjuvant treatment, and 440 (91 %) received adjuvant chemotherapy. In multivariate analysis, stage III–IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III–IV disease, performance status 2–4, ≥50 % myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS.
Conclusions
Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.