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