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

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Abstract

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.

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References

  1. Jonson AL, Bliss RL, Truskinovsky A et al (2006) Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 100:561–564

    Article  PubMed  Google Scholar 

  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 23:295–299

    CAS  PubMed  Google Scholar 

  3. Bansal N, Herzog TJ, Seshan VE et al (2008) Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol 112:64–70

    Article  PubMed  Google Scholar 

  4. Major FJ, Blessing JA, Silverberg SG et al (1993) Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 71:1702–1709

    Article  CAS  PubMed  Google Scholar 

  5. Pacaut C, Bourmaud A, Rivoirard R et al (2015) Uterine and ovary carcinosarcomas: outcome, prognosis factors, and adjuvant therapy. Am J Clin Oncol 38:272

    Article  CAS  PubMed  Google Scholar 

  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 58:786–796

    Article  PubMed  Google Scholar 

  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 17:123–132

    Article  CAS  PubMed  Google Scholar 

  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 143:88–92

    Article  CAS  PubMed  Google Scholar 

  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 111:82–88

    Article  PubMed  Google Scholar 

  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 17:861–868

    Article  PubMed  Google Scholar 

  11. Huang GS, Chiu LG, Gebb JS et al (2007) Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma. Gynecol Oncol 107:513–517

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Vorgias G, Fotiou S (2010) The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed Mullerian tumours): a critical literature review. Arch Gynecol Obstet 282:659–664

    Article  CAS  PubMed  Google Scholar 

  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 123:548–552

    Article  PubMed  Google Scholar 

  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. http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed 6 Mar 2015

  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 107:177–185

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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 28:2727–2731

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  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 25:92–97

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-0063, Japan

    Kenichi Harano

  2. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Akihiro Hirakawa

  3. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan

    Mayu Yunokawa

  4. Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan

    Toshiaki Nakamura

  5. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Toyomi Satoh

  6. Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan

    Tadaaki Nishikawa

  7. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Daisuke Aoki & Nobuyuki Susumu

  8. Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan

    Kimihiko Ito

  9. Department of Disaster Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Kiyoshi Ito

  10. Department of Gynecology, Aichi Cancer Center, Nagoya, Japan

    Toru Nakanishi

  11. Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan

    Kazuhiro Takehara

  12. Department of Clinical Research Network, Clinical Research Innovation and Education Center, Tohoku University Hospital, Sendai, Japan

    Yoh Watanabe

  13. Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Hidemichi Watari

  14. Department of Gynecology, National Kyushu Cancer Center, Fukuoka, Japan

    Toshiaki Saito

Authors
  1. Kenichi Harano
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  2. Akihiro Hirakawa
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  3. Mayu Yunokawa
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  4. Toshiaki Nakamura
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  5. Toyomi Satoh
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  6. Tadaaki Nishikawa
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  7. Daisuke Aoki
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  8. Kimihiko Ito
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  9. Kiyoshi Ito
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  10. Toru Nakanishi
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  11. Nobuyuki Susumu
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  12. Kazuhiro Takehara
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  13. Yoh Watanabe
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  14. Hidemichi Watari
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  15. Toshiaki Saito
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Corresponding author

Correspondence to Kenichi Harano.

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Harano, K., Hirakawa, A., Yunokawa, M. et al. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Int J Clin Oncol 21, 168–176 (2016). https://doi.org/10.1007/s10147-015-0859-7

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  • DOI: https://doi.org/10.1007/s10147-015-0859-7

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