International Journal of Clinical Oncology

, Volume 21, Issue 1, pp 168–176 | Cite as

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

  • Kenichi HaranoEmail author
  • Akihiro Hirakawa
  • Mayu Yunokawa
  • Toshiaki Nakamura
  • Toyomi Satoh
  • Tadaaki Nishikawa
  • Daisuke Aoki
  • Kimihiko Ito
  • Kiyoshi Ito
  • Toru Nakanishi
  • Nobuyuki Susumu
  • Kazuhiro Takehara
  • Yoh Watanabe
  • Hidemichi Watari
  • Toshiaki Saito
Original Article



Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known.


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.


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.


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.


Uterine carcinosarcoma Prognostic factor Pelvic lymph node Lymphadenectomy 



The following Japanese institutions participated in this study—National Cancer Center Hospital, Kagoshima City Hospital, University of Tsukuba, Saitama Medical University International Medical Center, Tohoku University Hospital, Aichi Cancer Center, Keio University Hospital, Yokohama City University Hospital, Jichi Medical University, The Jikei University Hospital, Himeji Red Cross Hospital, Kyoto University Hospital, Niigata Cancer Center Hospital, Saga University Hospital, National Civil Service Mutual Aid Association Tachikawa Hospital, Nagoya University Hospital, Nagoya City University Hospital, Musashino Red Cross Hospital, Asa City Hospital, Kyushu University Hospital, Tokai University Hospital, Niigata University Hospital, Ohji General Hospital, Kansai Medical University Hirakata Hospital, Tottori University Hospital, Fukuyama Medical Center, Hirosaki University Hospital, Fukushima Medical University Hospital, Toyohashi City Hospital, Kure Medical Center, Iwate Medical University Hospital, Tokyo Medical and Dental University Hospital, Tokushima University Hospital, Gifu University Hospital, Tokuyama Chuo Hospital, Shikoku Cancer Center, Kyushu Cancer Center, KKR Sapporo Medical Center, Toyama University Hospital, Tokyo Medical Center, Juntendo Nerima Hospital, Dokkyo Medical University Hospital, Kaizuka City Hospital, Hokkaido University Hospital, Kyoto Second Red Cross Hospital, Osaka Medical Center for Cancer and Cardiovascular Diseases, Yokohama City Hospital, Kousei Hospital, Hiroshima General Hospital, Sapporo Kosei Hospital, Nagasaki University Hospital, National Defense Medical College Hospital, Tokyo Women’s Medical University East Medical Center, Kansai Rosai Hospital, Saitama Medical Center, Juntendo University Hospital, Aichi Medical University Hospital, Juntendo University Urayasu Hospital, Kokura Kinen Hospital, Fukui University Hospital, University of Tokyo Hospital, Mitsui Memorial Hospital, Okinawa Chubu Hospital, Nagasaki City Hospital, Tomishiro Chuo Hospital, Kagawa Prefectural Central Hospital, Nippon Medical School Musashikosugi Hospital, Gunma Cancer Center, Nara Hospital, Shizuoka Red Cross Hospital, Misawa City Hospital, Mie Prefectural General Medical Center, Kyushu Medical Center, Tosei Hospital, Chugoku Rousai Hospital, Sapporo City Hospital, Tottori Prefectural Central Hospital, Omihachiman Community Medical Center, Kochi Medical Center, Kurume University Hospital, Hyogo Prefectural Tsukaguchi Hospital, Oita University Hospital, Izumi City Hospital, Asahikawa Medical Collage, JCHO Sagamino Hospital, Saiseikai Nagasaki Hospital, Yamaguchi Red Cross Hospital, Saiseikai Suita Hospital, and Ise Red Cross Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Jonson AL, Bliss RL, Truskinovsky A et al (2006) Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 100:561–564CrossRefPubMedGoogle Scholar
  2. 2.
    Gadducci A, Sartori E, Landoni F et al (2002) The prognostic relevance of histological type in uterine sarcomas: a Cooperation Task Force (CTF) multivariate analysis of 249 cases. Eur J Gynaecol Oncol 23:295–299PubMedGoogle Scholar
  3. 3.
    Bansal N, Herzog TJ, Seshan VE et al (2008) Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol 112:64–70CrossRefPubMedGoogle Scholar
  4. 4.
    Major FJ, Blessing JA, Silverberg SG et al (1993) Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 71:1702–1709CrossRefPubMedGoogle Scholar
  5. 5.
    Pacaut C, Bourmaud A, Rivoirard R et al (2015) Uterine and ovary carcinosarcomas: outcome, prognosis factors, and adjuvant therapy. Am J Clin Oncol 38:272CrossRefPubMedGoogle Scholar
  6. 6.
    Callister M, Ramondetta LM, Jhingran A et al (2004) Malignant mixed Mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 58:786–796CrossRefPubMedGoogle Scholar
  7. 7.
    Larson B, Silfversward C, Nilsson B et al (1990) Mixed Mullerian tumours of the uterus-prognostic factors: a clinical and histopathologic study of 147 cases. Radiother Oncol 17:123–132CrossRefPubMedGoogle Scholar
  8. 8.
    Galaal K, Kew FM, Tam KF et al (2009) Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Obstet Gynecol Reprod Biol 143:88–92CrossRefPubMedGoogle Scholar
  9. 9.
    Nemani D, Mitra N, Guo M et al (2008) Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 111:82–88CrossRefPubMedGoogle Scholar
  10. 10.
    Park JY, Kim DY, Kim JH et al (2010) The role of pelvic and/or para-aortic lymphadenectomy in surgical management of apparently early carcinosarcoma of uterus. Ann Surg Oncol 17:861–868CrossRefPubMedGoogle Scholar
  11. 11.
    Huang GS, Chiu LG, Gebb JS et al (2007) Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma. Gynecol Oncol 107:513–517PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Vorgias G, Fotiou S (2010) The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed Mullerian tumours): a critical literature review. Arch Gynecol Obstet 282:659–664CrossRefPubMedGoogle Scholar
  13. 13.
    Tanner EJ, Leitao MM Jr, Garg K et al (2011) The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecol Oncol 123:548–552CrossRefPubMedGoogle Scholar
  14. 14.
    Koh WJ, Greer BE, Abu-Rustum NR et al (2015) Uterine neoplasms. In the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, version 2. Available via the NCCN. Accessed 6 Mar 2015
  15. 15.
    Wolfson AH, Brady MF, Rocereto T et al (2007) A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin–ifosfamide and mesna (CIM) as post-surgical therapy in stage I–IV carcinosarcoma (CS) of the uterus. Gynecol Oncol 107:177–185PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Powell MA, Filiaci VL, Rose PG et al (2010) Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol 28:2727–2731PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Otsuki A, Watanabe Y, Nomura H et al (2015) Paclitaxel and carboplatin in patients with completely or optimally resected carcinosarcoma of the uterus: a phase II trial by the Japanese Uterine Sarcoma Group and the Tohoku Gynecologic Cancer Unit. Int J Gynecol Cancer 25:92–97CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2015

Authors and Affiliations

  • Kenichi Harano
    • 1
    Email author
  • Akihiro Hirakawa
    • 2
  • Mayu Yunokawa
    • 3
  • Toshiaki Nakamura
    • 4
  • Toyomi Satoh
    • 5
  • Tadaaki Nishikawa
    • 6
  • Daisuke Aoki
    • 7
  • Kimihiko Ito
    • 8
  • Kiyoshi Ito
    • 9
  • Toru Nakanishi
    • 10
  • Nobuyuki Susumu
    • 7
  • Kazuhiro Takehara
    • 11
  • Yoh Watanabe
    • 12
  • Hidemichi Watari
    • 13
  • Toshiaki Saito
    • 14
  1. 1.Department of Medical OncologyNippon Medical School Musashikosugi HospitalKawasakiJapan
  2. 2.Center for Advanced Medicine and Clinical ResearchNagoya University HospitalNagoyaJapan
  3. 3.Department of Breast and Medical OncologyNational Cancer Center HospitalTokyoJapan
  4. 4.Department of Obstetrics and GynecologyKagoshima City HospitalKagoshimaJapan
  5. 5.Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  6. 6.Department of Gynecologic OncologySaitama Medical University International Medical CenterHidakaJapan
  7. 7.Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
  8. 8.Department of Obstetrics and GynecologyKansai Rosai HospitalAmagasakiJapan
  9. 9.Department of Disaster Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiJapan
  10. 10.Department of GynecologyAichi Cancer CenterNagoyaJapan
  11. 11.Department of Gynecologic OncologyShikoku Cancer CenterMatsuyamaJapan
  12. 12.Department of Clinical Research Network, Clinical Research Innovation and Education CenterTohoku University HospitalSendaiJapan
  13. 13.Department of Obstetrics and GynecologyHokkaido University Graduate School of MedicineSapporoJapan
  14. 14.Department of GynecologyNational Kyushu Cancer CenterFukuokaJapan

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