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International Journal of Clinical Oncology

, Volume 23, Issue 1, pp 114–120 | Cite as

Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma

  • Yavuz Emre Şükür
  • Salih Taşkın
  • Bulut Varlı
  • Can Ateş
  • Mete Güngör
  • Fırat Ortaç
Original Article
  • 177 Downloads

Abstract

Background

Uterine carcinosarcoma (UCS) is a relatively rare and very aggressive tumor. The predictors of survival for patients with UCS have not been determined clearly yet. The aim of the present study was to investigate the possible predictors of disease-free survival (DFS) and overall survival (OS) for patients with UCS.

Methods and materials

All patients with UCS who were treated surgically at a university-based Gynecology Oncology Clinic between January 2008 and December 2014 were recruited into this retrospective cohort study. Data regarding clinical, pathologic and treatment information were obtained retrospectively from hospital records. The Kaplan–Meier method was used to calculate DFS and OS, and Cox regression analysis was performed to define the effects of risk factors on survival.

Results

A total of 88 UCS patients with a median age of 64.5 years were included in the study. Forty-seven (53.4%) patients were diagnosed with stage III disease and seven (7.9%) with stage IV disease. The median follow-up time was 16 months. Among all patients, 60 (68.1%) underwent lymphadenectomy. Optimal cytoreductive surgery was achieved in 67 (76.1%) patients. Stepwise variable selection Cox regression analysis showed that lymph node metastasis was associated with poor DFS (hazard ratio 6.524; 95% CI 2.625–16.211; P < 0.001) and OS (hazard ratio 6.993; 95% CI 2.631–18.587; P < 0.001). Subgroup analysis in both early and advanced-stage diseases revealed no significant impact of risk factors on survival.

Conclusions

Lymph node metastasis is the most significant prognostic factor associated with poor DFS and OS in UCS patients.

Keywords

Lymphadenectomy Lymph node metastasis Residual tumor Survival Uterine carcinosarcoma 

Notes

Author contributions

YES: data management, manuscript writing/editing; ST: protocol/project development, interpretation, management; BV: data collection; CA: data analysis; MG: interpretation, critical reviews; FO: interpretation, critical reviews.

Compliance with ethical standards

Conflict of interest

The authors of this article report no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional review board and with the Helsinki declaration or comparable ethical standards.

References

  1. 1.
    Cantrell LA, Blank SV, Duska LR (2015) Uterine carcinosarcoma: a review of the literature. Gynecol Oncol 137:581–588CrossRefPubMedGoogle Scholar
  2. 2.
    Jonson AL, Bliss RL, Truskinovsky A et al (2006) Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 100:561–564CrossRefPubMedGoogle Scholar
  3. 3.
    Bansal N, Herzog TJ, Seshan VE et al (2008) Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behaviour. Obstet Gynecol 112:64–70CrossRefPubMedGoogle Scholar
  4. 4.
    Temkin SM, Hellmann M, Lee YC et al (2007) Early-stage carcinosarcoma of the uterus: the significance of lymph node count. Int J Gynecol Cancer 17:215–219CrossRefPubMedGoogle Scholar
  5. 5.
    Hoellen F, Waldmann A, Benthin S et al (2014) The role of lympadenectomy in uterine sarcoma: a clinical practical approach based on retrospective analysis. Anticancer Res 34:985–993PubMedGoogle Scholar
  6. 6.
    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
  7. 7.
    Sorbe B, Paulsson G, Andersson S et al (2013) A population-based series of uterine carcinosarcomas with long-term follow-up. Acta Oncol 52:759–766CrossRefPubMedGoogle Scholar
  8. 8.
    Alagkiozidis I, Grossman A, Tang NZ et al (2015) Survival impact of cytoreduction to microscoic disease for advanced stage cancer of the uterine corpus: a retrospective cohort study. Int J Surg 4:61–66CrossRefGoogle Scholar
  9. 9.
    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
  10. 10.
    Harano K, Hirakawa A, Yunokawa M et al (2016) Optimal cytoreductive surgery in patients with advanced uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Gynecol Oncol 141:447–453CrossRefPubMedGoogle Scholar
  11. 11.
    Harano K, Hirakawa A, Yunokawa M et al (2016) Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Int J Clin Oncol 21:168–176CrossRefPubMedGoogle Scholar
  12. 12.
    Thomas MB, Mariani A (2007) Role of cytoreduction in stage III and IV uterine papillary serous carcinoma. Gynecol Oncol 107:190–193CrossRefPubMedGoogle Scholar
  13. 13.
    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
  14. 14.
    Bodner-Adler B, Bodner K, Obermair A et al (2001) Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study. Anticancer Res 21:3069–3074PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Park JY, Kim DY, Kim JH et al (2010) The role of pelvic and/or para-aortic lymphadenectomy in surgical management of apparently early carcinosarcoa of uterus. Ann Surg Oncol 17:861–868CrossRefPubMedGoogle Scholar
  17. 17.
    Matsuo K, Omatsu K, Ross MS et al (2017) Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecol Oncol 145:78–87CrossRefPubMedGoogle Scholar
  18. 18.
    Powell MA, Filiaci PG, 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 28:2727–2731CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    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 Tohoku Gynecologic Cancer Unit. Int J Gynecol Cancer 25:92–97CrossRefPubMedGoogle Scholar
  20. 20.
    Takano T, Otsuki T, Tokunaga H et al (2014) Paclitaxel-carboplatin for advanced or recurrent carcinosarcoma of the uterus: the Japan Uterine Sarcoma Group and Tohoku Gynecologic Cancer Unit Study. Int J Clin Oncol 19:1052–1058CrossRefPubMedGoogle Scholar
  21. 21.
    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
  22. 22.
    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 107:177–185CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Reed NS, Mangioni C, Malmström H et al (2008) Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: a European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 44:808–818CrossRefPubMedGoogle Scholar
  24. 24.
    Zwahlen DR, Schick U, Bolukbasi Y et al (2016) Outcome and predictive factors in uterine carcinosarcoma using postoperative radiotherapy: a RARE Cancer Network Study. Rare Tumors 8:6052CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyAnkara University School of MedicineAnkaraTurkey
  2. 2.Department of BiostatisticsAnkara University School of MedicineAnkaraTurkey
  3. 3.Department of Obstetrics and GynecologyAcıbadem University School of MedicineIstanbulTurkey

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