Skip to main content

Advertisement

SpringerLink
Log in

Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to evaluate the outcome of patients with uterine carcinosarcoma undergoing sentinel lymph node (SLN) mapping.

Methods

A prospectively maintained database was reviewed for all women with uterine cancer treated at our institution from January 1, 1998 to August 31, 2014. Patients were grouped based on whether they had undergone SLN mapping or routine lymphadenectomy at the time of staging. SLN evaluation was performed according to a standard institutional protocol that incorporates a surgical algorithm and pathologic ultrastaging.

Results

We identified 136 patients with uterine carcinosarcoma who had undergone lymph node evaluation; 48 had surgical staging with SLN mapping and 88 had routine lymphadenectomy consisting of pelvic and/or para-aortic lymph node dissection. Stage distribution for the SLN group included: stage I, 31 (65 %); stage II, 1 (2 %); stage III, 11 (23 %); stage IV, 5 (10 %). Stage distribution for the non-SLN group included: stage I, 48 (55 %); stage II, 4 (4 %); stage III, 19 (22 %); stage IV, 17 (19 %) (p = 0.4). Median number of lymph nodes removed was 8 and 20, respectively (p ≤ 0.001). Median number of positive nodes was similar between the groups (p = 0.2). Of the 67 patients who had a documented recurrence, 14 of 20 (70 %) in the SLN and 34 of 47 (74 %) in the non-SLN group demonstrated a distant/multifocal pattern of recurrence. There was no difference in median progression-free survival between the groups (23 vs. 23.2 months, respectively; p = 0.7).

Conclusions

Progression-free survival in women with uterine carcinosarcoma undergoing SLN mapping with adjuvant therapy appears similar to that of patients treated before the incorporation of the SLN protocol. Additional prospective studies with longer follow-up are necessary to validate these early results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Desai NB, Kollmeier MA, Makker V, Levine DA, Abu-Rustum NR, Alektiar KM. Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma. Gynecol Oncol. 2014;135:49–53.

    Article  PubMed  Google Scholar 

  2. Rovirosa A, Ascaso C, Arenas M, et al. Pathologic prognostic factors in stage I-III uterine carcinosarcoma treated with postoperative radiotherapy. Arch Gynecol Obstet. 2014;290:329–34.

    PubMed  Google Scholar 

  3. Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993; 71:1702–9.

    Article  PubMed  CAS  Google Scholar 

  4. Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer. 2000;88:2782–6.

    Article  PubMed  CAS  Google Scholar 

  5. Rovirosa A, Ascaso C, Ordi J, et al. 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. 2002;52:1320–9.

    Article  PubMed  Google Scholar 

  6. Rovirosa A, Ascaso C, Ordi J, et al. How to deal with prognostic factors and radiotherapy results in uterine neoplasms with a sarcomatous component? Clin Transl Oncol. 2009;11:681–7.

    Article  PubMed  Google Scholar 

  7. Arend R, Doneza JA, Wright JD. Uterine carcinosarcoma. Curr Opin Oncol. 2011;23:531–6.

    PubMed  Google Scholar 

  8. Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw. 2014;12:288–97.

    PubMed  Google Scholar 

  9. Abu-Rustum NR, Gomez JD, Alektiar KM, et al. The incidence of isolated paraaortic nodal metastasis in surgically staged endometrial cancer patients with negative pelvic lymph nodes. Gynecol Oncol. 2009;115:236–8.

    Article  PubMed  Google Scholar 

  10. Soliman PT, Frumovitz M, Spannuth W, et al. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol. 2010;119:291–4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Barlin JN, Khoury-Collado F, Kim CH, et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125:531–5.

    Article  PubMed  Google Scholar 

  12. Khoury-Collado F, Glaser GE, Zivanovic O, et al. Improving sentinel lymph node detection rates in endometrial cancer: how many cases are needed? Gynecol Oncol. 2009;115:453–5.

    Article  PubMed  Google Scholar 

  13. Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113:163–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Leitao MM Jr, Khoury-Collado F, Gardner G, et al. Impact of incorporating an algorithm that utilizes sentinel lymph node mapping during minimally invasive procedures on the detection of stage IIIC endometrial cancer. Gynecol Oncol. 2013;129:38–41.

    Article  PubMed  Google Scholar 

  15. Jewell EL, Huang JJ, Abu-Rustum NR, et al. Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol. 2014;133:274–7.

    Article  PubMed  Google Scholar 

  16. How J, Gotlieb WH, Press JZ, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015. doi:10.1016/j.ygyno.2015.04.004.

  17. Khoury-Collado F, Murray MP, Hensley ML, et al. Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol Oncol. 2011;122:251–4.

    Article  PubMed  CAS  Google Scholar 

  18. Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol. 2008;111:82–8.

    Article  PubMed  Google Scholar 

  19. Naoura I, Canlorbe G, Bendifallah S, Ballester M, Darai E. Relevance of sentinel lymph node procedure for patients with high-risk endometrial cancer. Gynecol Oncol. 2015;136:60–4.

    Article  PubMed  Google Scholar 

  20. Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.

    Article  PubMed  Google Scholar 

  21. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.

    Article  Google Scholar 

  22. Reed NS, Mangioni C, Malmstrom H, et al. 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. 2008;44:808–18.

    Article  PubMed  CAS  Google Scholar 

  23. Makker V, Abu-Rustum NR, Alektiar KM, et al. A retrospective assessment of outcomes of chemotherapy-based versus radiation-only adjuvant treatment for completely resected stage I-IV uterine carcinosarcoma. Gynecol Oncol. 2008;111:249–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cantrell LA, Havrilesky L, Moore DT, et al. A multi-institutional cohort study of adjuvant therapy in stage I-II uterine carcinosarcoma. Gynecol Oncol. 2012;127:22–6.

    Article  PubMed  Google Scholar 

  25. Abu-Rustum NR, Alektiar K, Iasonos A, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714–8.

    Article  PubMed  Google Scholar 

  26. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375:1165–72.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Funded in part by the cancer center core grant P30 CA008748. The core grant provides funding to institutional cores, such as Biostatistics and Pathology, which were used in this study.

Disclosures

Dr. Soslow reports grants from the NIH, grants from the Department of Defense, personal fees from EMD Serono, personal fees from Cambridge University Press, and personal fees from Springer Publishing, outside of the submitted work. The other authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Maria B. Schiavone MD, Oliver Zivanovic MD, PhD, Mario M. Leitao Jr. MD, Douglas A. Levine MD & Nadeem R. Abu-Rustum MD

  2. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

    Oliver Zivanovic MD, PhD, Mario M. Leitao Jr. MD, Douglas A. Levine MD & Nadeem R. Abu-Rustum MD

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Qin Zhou MA & Alexia Iasonos PhD

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert A. Soslow MD

  5. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA

    Robert A. Soslow MD

  6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kaled M. Alektiar MD

  7. Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Vicky Makker MD

  8. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Vicky Makker MD

Authors
  1. Maria B. Schiavone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oliver Zivanovic MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qin Zhou MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario M. Leitao Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas A. Levine MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert A. Soslow MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kaled M. Alektiar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vicky Makker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexia Iasonos PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nadeem R. Abu-Rustum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadeem R. Abu-Rustum MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schiavone, M.B., Zivanovic, O., Zhou, Q. et al. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol 23, 196–202 (2016). https://doi.org/10.1245/s10434-015-4612-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4612-2

Keywords

Search

Navigation