Abstract
Background
Uterine carcinosarcomas are rare and highly aggressive tumours. Although surgery is the cornerstone of treatment, the extent of the procedure remains controversial. We sought to evaluate the available literature data regarding the rationale of lymphadenectomy and its possible impact on survival.
Methods
A systematic Medline, PubMed and Scopus search with special focus on the publications of the last decade.
Results
Carcinosarcomas have similar clinical characteristics and behaviour with grade 3 endometrioid or aggressive variants of uterine adenocarcinoma. All studies have demonstrated that the FIGO stage of disease is the most important prognostic factor, followed by the depth of myometrial invasion, extra-uterine spread and positive peritoneal cytology. Moreover, lymph node involvement will be found in 14–38% of patients undergoing lymphadenectomy. This figure is similar to the one reported for endometrial carcinoma. Therefore, lymphadenectomy is mandatory for staging purposes. Regarding its impact on survival, the majority of studies confirm a significant survival benefit. The possible mechanisms for the improvement of survival from lymphadenectomy include removal of micro-metastatic foci, reduction of recurrence risk (removal of “target tissue”) and mechanical circumvallate of the disease. Given that 5–38% of the patients will experience local recurrence and 30–83% distant metastases, lymphadenectomy reduces the risk of the first and identifies patients in advanced stage that may benefit from adjuvant chemotherapy, aiming to reduce the second and ultimately improve overall survival.
Conclusions
Our review data fully justifies the rationale of lymphadenectomy, which beyond staging information seems to offer a measurable survival benefit.
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References
Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ (2000) Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer 88(12):2782–2786
Arrastia CD, Fruchter RG, Clark M, Maiman M, Remy JC, Macasaet M, Gates EJ, Di Maio T, Marzec T (1997) Uterine carcinosarcomas: incidence and trends in management and survival. Gynecol Oncol 65(1):158–163
Nordal RR, Thoresen SO (1997) Uterine sarcomas in Norway 1956–1992: incidence, survival and mortality. Eur J Cancer 33(6):907–911
Dinh TV, Slavin RE, Bhagavan BS, Hannigan EV, Tiamson EM, Yandell RB (1989) Mixed müllerian tumors of the uterus: a clinicopathologic study. Obstet Gynecol 74(3 Pt 1):388–392
Kahanpää KV, Wahlström T, Gröhn P, Heinonen E, Nieminen U, Widholm O (1986) Sarcomas of the uterus: a clinicopathologic study of 119 patients. Obstet Gynecol 67(3):417–424
Schweizer W, Demopoulos R, Beller U, Dubin N (1990) Prognostic factors for malignant mixed müllerian tumors of the uterus. Int J Gynecol Pathol 9(2):129–136
Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ (2004) Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 58(3):786–796
Galaal K, Kew FM, Tam KF, Lopes A, Meirovitz M, Naik R, Godfrey KA, Hatem MH, Edmondson RJ (2009) Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Obstet Gynecol Reprod Biol 143(2):88–92 Epub 2009 Feb 7
Nemani D, Mitra N, Guo M, Lin L (2008) Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 111(1):82–88
Morice P, Rodrigues A, Pautier P, Rey A, Camatte S, Atallah D, Pomel C, Lhommé C, Haie-Meder C, Duvillard P, Castaigne D (2003) Surgery for uterine sarcoma: review of the literature and recommendations for the standard surgical procedure. Gynecol Obstet Fertil 31(2):147–150
Wright JD, Seshan VE, Shah M, Schiff PB, Burke WM, Cohen CJ, Herzog TJ (2008) The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma. Am J Obstet Gynecol 199(5):536.e1–536.e8 (Epub 3 June 2008)
Park JY, Kim DY, Kim JH, kim YT, Nam JH (2010) The role of pelvic and/or para-aortic lymphadenectomy in surgical management of apparently early stage carcinosarcoma of uterus. Ann Surg Oncol 17(3):861–868
Winter R, Ostor A, Kapp K, Petru E (2004) Primary treatment of uterine sarcomas. In: Gershenson DM, McGuire WP, Gore M, Quinn MA, Thomas G (eds) Gynecologic cancer. Controversies in management. Elsevier, New York, pp 301–316
Sutton G, Kavanagh J, Wolfson A, Tornos C (2005) Corpus: mesenchymal tumors. In: Hoskins WJ, Perez CA, Young RC, Barakat RR, Markman M, Randall ME (eds) Principles and practice of gynecologic oncology, 4th edn. Lippincott, Philadelphia, pp 873–894
Hacker NF (2005) Uterine cancer. In: Berek JS, Hacker NF (eds) Practical gynecologic oncology, 4th edn. Lippincott, Philadelphia, pp 397–442
Hacker NF, Marsden DE (2006) Surgery for uterine cancer. In: Luesley DM, Lawton FG, Berchuck A (eds) Uterine cancer. Taylor & Francis, London, pp 142–144
Kitchener HC, Trimble EL (2009) Endometrial cancer state of the art meeting. Int J Gynecol Cancer 19(1):134–140
Iwasa Y, Haga H, Konishi I, Kobashi Y, Higuchi K, Katsuyama E, Minamiguchi S, Yamabe H (1998) Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients. Cancer 82(3):512–519
McCluggage WG (2002) Uterine carcinosarcomas (malignant mixed Mullerian tumors) are metaplastic carcinomas. Int J Gynecol Cancer 12(6):687–690
McCluggage WG (2002) Recent advances in immunohistochemistry in gynaecological pathology. Histopathology 40(4):309–326
Brown L (2008) Pathology of uterine malignancies. Clin Oncol (R Coll Radiol) 20(6):433–447 Epub 2008 May 21
Kernochan LE, Garcia RL (2009) Carcinosarcomas (malignant mixed Müllerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw 7(5):550–556
Nola M, Babić D, Ilić J, Marusić M, Uzarević B, Petrovecki M, Sabioncello A, Kovac D, Jukić S (1996) Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus. Cancer 78(12):2543–2550
Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Jacomen G, Van Robaeys J, Neven P, Moerman P, Vergote I (2005) Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol 98(2):274–280
Rovirosa A, Ascaso C, Ordi J, Abellana R, Arenas M, Lejarcegui JA, Pahisa J, Puig-Tintoré LM, Mellado B, Armenteros B, Iglesias X, Biete A (2002) Is vascular and lymphatic space invasion a main prognostic factor in uterine neoplasms with a sarcomatous component? A retrospective study of prognostic factors of 60 patients stratified by stages. Int J Radiat Oncol Biol Phys 52(5):1320–1329
Benito V, Lubrano A, Arencibia O, Andújar M, Alvarez E, Medina N, Falcón JM, Falcón O (2009) Clinicopathologic analysis of uterine sarcomas from a single institution in the Canary Islands. Int J Gynaecol Obstet (Epub ahead of print)
Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH (2008) Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989–2007. J Cancer Res Clin Oncol 134(12):1277–1287 Epub 2008 May 28
Kokawa K, Nishiyama K, Ikeuchi M, Ihara Y, Akamatsu N, Enomoto T, Ishiko O, Motoyama S, Fujii S, Umesaki N (2006) Clinical outcomes of uterine sarcomas: results from 14 years worth of experience in the Kinki district in Japan (1990–2003). Int J Gynecol Cancer 16(3):1358–1363
Wu TI, Hsu KH, Huang HJ, Hsueh S, Chou HH, Tsai CS, Ho KC, Chao A, Chang TC, Lai CH (2008) Prognostic factors and adjuvant therapy in uterine carcinosarcoma. Eur J Gynaecol Oncol 29(5):483–488
Nordal RR, Kristensen GB, Stenwig AE, Nesland JM, Pettersen EO, Trope CG (1997) An evaluation of prognostic factors in uterine carcinosarcoma. Gynecol Oncol 67(3):316–321
Yalman D, Ozsaran Z, Baltalarli B, Demir O, Ozdemir N, Aras A (2008) Results of postoperative radiotherapy in the treatment of uterine sarcomas: a retrospective analysis of 46 patients. Eur J Gynaecol Oncol 29(1):46–51
El Husseiny G, Al Bareedy N, Mourad WA, Mohamed G, Shoukri M, Subhi J, Ezzat A (2002) Prognostic factors and treatment modalities in uterine sarcoma. Am J Clin Oncol 25(3):256–260
Inthasorn P, Carter J, Valmadre S, Beale P, Russell P, Dalrymple C (2002) Analysis of clinicopathologic factors in malignant mixed Müllerian tumors of the uterine corpus. Int J Gynecol Cancer 12(4):348–353
Ozguroglu M, Bilici A, Ilvan S, Turna H, Atalay B, Mandel N, Sahinler I (2008) Determining predominating histologic component in malignant mixed Müllerian tumors: is it worth it? Int J Gynecol Cancer 18(4):809–812 Epub 2007 Sep 24
Leath CA 3rd, Numnum TM, Kendrick JE 4th, Frederick PJ, Rocconi RP, Conner MG, Straughn JM Jr (2009) Patterns of failure for conservatively managed surgical stage I uterine carcinosarcoma: implications for adjuvant therapy. Int J Gynecol Cancer 19(5):888–891
Gadducci A, Cosio S, Romanini A, Genazzani AR (2008) The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 65(2):129–142 Epub 2007 Aug 13. Review
Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, Yordan E, Brady MF (1993) Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 71(4 Suppl):1702–1709
Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, Heintz AP, Ngan HY, Pecorelli S (2006) Carcinoma of the corpus uteri. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95(Suppl 1):S105–S143
Ayhan A, Tuncer ZS, Tanir M, Yüce K, Ayhan A (1997) Uterine sarcoma: the Hacettepe hospital experience of 88 consecutive patients. Eur J Gynaecol Oncol 18(2):146–148
Temkin SM, Hellmann M, Lee YC, Abulafia O (2007) Early-stage carcinosarcoma of the uterus: the significance of lymph node count. Int J Gynecol Cancer 17(1):215–219
Akahira J, Tokunaga H, Toyoshima M, Takano T, Nagase S, Yoshinaga K, Tase T, Wada Y, Ito K, Niikura H, Yamada H, Sato A, Sasano H, Yaegashi N (2006) Prognoses and prognostic factors of carcinosarcoma, endometrial stromal sarcoma and uterine leiomyosarcoma: a comparison with uterine endometrial adenocarcinoma. Oncology 71(5–6):333–340 Epub 2007 Aug 9
Sagae S, Yamashita K, Ishioka S, Nishioka Y, Terasawa K, Mori M, Yamashiro K, Kanemoto T, Kudo R (2004) Preoperative diagnosis and treatment results in 106 patients with uterine sarcoma in Hokkaido, Japan. Oncology 67(1):33–39
Manolitsas TP, Wain GV, Williams KE, Freidlander M, Hacker NF (2001) Multimodality therapy for patients with clinical Stage I and II malignant mixed Müllerian tumors of the uterus. Cancer 91(8):1437–1443
Reed NS, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, Tateo S, Franchi M, Jobsen JJ, Coens C, Teodorovic I, Vergote I, Vermorken JB (2008) European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 44(6):808–18 (Epub 2008 Apr 2). Erratum in: Eur J Cancer. 2008 Jul; 44(11):1612
Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones MW (1998) The impact of adjuvant radiotherapy on carcinosarcoma of the uterus. Gynecol Oncol 68(1):8–13
Shimizu S, Yajima M, Yoshii A, Nishikawa T, Ohta H (2009) Malignant pericardial effusion and cardiac tamponade originating from uterine carcinosarcoma. Arch Gynecol Obstet 279(3):373–375 Epub 2008 Jun 12
Yoney A, Eren B, Eskici S, Salman A, Unsal M (2008) Retrospective analysis of 105 cases with uterine sarcoma. Bull Cancer 95(3):E10–17
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Vorgias, G., Fotiou, S. The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Arch Gynecol Obstet 282, 659–664 (2010). https://doi.org/10.1007/s00404-010-1649-0
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DOI: https://doi.org/10.1007/s00404-010-1649-0