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Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3676–3684 | Cite as

Proposal for a Risk-Based Categorization of Uterine Carcinosarcoma

  • Koji Matsuo
  • Yutaka Takazawa
  • Malcolm S. Ross
  • Esther Elishaev
  • Mayu Yunokawa
  • Todd B. Sheridan
  • Stephen H. Bush
  • Merieme M. Klobocista
  • Erin A. Blake
  • Tadao Takano
  • Tsukasa Baba
  • Shinya Satoh
  • Masako Shida
  • Yuji Ikeda
  • Sosuke Adachi
  • Takuhei Yokoyama
  • Munetaka Takekuma
  • Shiori Yanai
  • Satoshi Takeuchi
  • Masato Nishimura
  • Keita Iwasaki
  • Marian S. Johnson
  • Masayuki Yoshida
  • Ardeshir Hakam
  • Hiroko Machida
  • Paulette Mhawech-Fauceglia
  • Yutaka Ueda
  • Kiyoshi Yoshino
  • Hiroshi Kajiwara
  • Kosei Hasegawa
  • Masanori Yasuda
  • Takahito M. Miyake
  • Takuya Moriya
  • Yoshiaki Yuba
  • Terry Morgan
  • Tomoyuki Fukagawa
  • Tanja Pejovic
  • Tadayoshi Nagano
  • Takeshi Sasaki
  • Abby M. Richmond
  • Miriam D. Post
  • Mian M. K. Shahzad
  • Dwight D. Im
  • Hiroshi Yoshida
  • Takayuki Enomoto
  • Kohei Omatsu
  • Frederick R. Ueland
  • Joseph L. Kelley
  • Rouzan G. Karabakhtsian
  • Lynda D. Roman
Gynecologic Oncology

Abstract

Purpose

To propose a categorization model of uterine carcinosarcoma (UCS) based on tumor cell types (carcinoma and sarcoma) and sarcoma dominance.

Methods

This secondary analysis of a prior multicenter retrospective study examined 889 cases of UCS with available histologic evaluation. Based on survival outcome, cases were clustered into three groups: low-grade carcinoma with nondominant homologous sarcoma [type A, n = 96 (10.8%)], (1) low-grade carcinoma with heterologous sarcoma or any sarcoma dominance and (2) high-grade carcinoma with nondominant homologous sarcoma [type B, n = 412 (46.3%)], and high-grade carcinoma with heterologous sarcoma or any sarcoma dominance [type C, n = 381 (42.9%)]. Tumor characteristics and outcome were examined based on the categorization.

Results

Women in type C category were more likely to be older, obese, and Caucasian, whereas those in type A category were younger, less obese, Asian, and nulligravid (all P < 0.01). Type C tumors were more likely to have metastatic implants, large tumor size, lymphovascular space invasion with sarcoma cells, and higher lymph node ratio, whereas type A tumors were more likely to be early-stage disease and small (all P < 0.05). On multivariate analysis, tumor categorization was independently associated with progression-free survival (5-year rates: 70.1% for type A, 48.3% for type B, and 35.9% for type C, adjusted P < 0.01) and cause-specific survival (5-year rates: 82.8% for type A, 63.0% for type B, and 47.1% for type C, adjusted P < 0.01).

Conclusion

Characteristic differences in clinicopathological factors and outcomes in UCS imply that different underlying etiologies and biological behaviors may be present, supporting a new classification system.

Notes

Funding

Ensign Endowment for Gynecologic Cancer Research (K.M.)

Disclosure

The authors declare that there is no conflict of interest for all authors.

Supplementary material

10434_2018_6695_MOESM1_ESM.docx (138 kb)
Supplementary material 1 (DOCX 137 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Koji Matsuo
    • 1
  • Yutaka Takazawa
    • 4
  • Malcolm S. Ross
    • 5
  • Esther Elishaev
    • 6
  • Mayu Yunokawa
    • 9
  • Todd B. Sheridan
    • 12
  • Stephen H. Bush
    • 13
  • Merieme M. Klobocista
    • 15
  • Erin A. Blake
    • 17
  • Tadao Takano
    • 19
  • Tsukasa Baba
    • 21
  • Shinya Satoh
    • 22
  • Masako Shida
    • 23
  • Yuji Ikeda
    • 27
  • Sosuke Adachi
    • 29
  • Takuhei Yokoyama
    • 30
  • Munetaka Takekuma
    • 31
  • Shiori Yanai
    • 32
  • Satoshi Takeuchi
    • 39
  • Masato Nishimura
    • 41
  • Keita Iwasaki
    • 42
  • Marian S. Johnson
    • 7
  • Masayuki Yoshida
    • 10
  • Ardeshir Hakam
    • 14
  • Hiroko Machida
    • 1
  • Paulette Mhawech-Fauceglia
    • 2
  • Yutaka Ueda
    • 20
  • Kiyoshi Yoshino
    • 20
  • Hiroshi Kajiwara
    • 24
  • Kosei Hasegawa
    • 25
  • Masanori Yasuda
    • 26
  • Takahito M. Miyake
    • 33
  • Takuya Moriya
    • 34
  • Yoshiaki Yuba
    • 36
  • Terry Morgan
    • 38
  • Tomoyuki Fukagawa
    • 40
  • Tanja Pejovic
    • 37
  • Tadayoshi Nagano
    • 35
  • Takeshi Sasaki
    • 28
  • Abby M. Richmond
    • 18
  • Miriam D. Post
    • 18
  • Mian M. K. Shahzad
    • 13
  • Dwight D. Im
    • 11
  • Hiroshi Yoshida
    • 10
  • Takayuki Enomoto
    • 29
  • Kohei Omatsu
    • 3
  • Frederick R. Ueland
    • 7
  • Joseph L. Kelley
    • 5
  • Rouzan G. Karabakhtsian
    • 8
    • 16
  • Lynda D. Roman
    • 1
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of PathologyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of GynecologyCancer Institute HospitalTokyoJapan
  4. 4.Department of PathologyCancer Institute HospitalTokyoJapan
  5. 5.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of PittsburghPittsburghUSA
  6. 6.Department of Pathology, MaGee-Womens HospitalUniversity of PittsburghPittsburghUSA
  7. 7.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Kentucky Medical CenterLexingtonUSA
  8. 8.Department of PathologyUniversity of Kentucky Medical CenterLexingtonUSA
  9. 9.Department of Breast and Medical OncologyNational Cancer Center HospitalTokyoJapan
  10. 10.Department of PathologyNational Cancer Center HospitalTokyoJapan
  11. 11.Department of GynecologyMercy Medical CenterBaltimoreUSA
  12. 12.Department of PathologyMercy Medical CenterBaltimoreUSA
  13. 13.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of South FloridaTampaUSA
  14. 14.Department of PathologyMoffitt Cancer Center, University of South FloridaTampaUSA
  15. 15.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyMontefiore Medical CenterNew York CityUSA
  16. 16.Department of Pathology, Albert Einstein College of MedicineMontefiore Medical CenterNew York CityUSA
  17. 17.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of ColoradoDenverUSA
  18. 18.Department of PathologyUniversity of ColoradoDenverUSA
  19. 19.Department of Obstetrics and GynecologyTohoku UniversityMiyagiJapan
  20. 20.Department of Obstetrics and GynecologyOsaka UniversityOsakaJapan
  21. 21.Department of Obstetrics and GynecologyKyoto UniversityKyotoJapan
  22. 22.Department of Obstetrics and GynecologyTottori UniversityTottoriJapan
  23. 23.Department of Obstetrics and GynecologyTokai UniversityKanagawaJapan
  24. 24.Department of PathologyTokai UniversityKanagawaJapan
  25. 25.Department of Gynecologic OncologySaitama Medical University International Medical CenterSaitamaJapan
  26. 26.Department of PathologySaitama Medical University International Medical CenterSaitamaJapan
  27. 27.Department of Obstetrics and GynecologyThe University of TokyoTokyoJapan
  28. 28.Department of PathologyThe University of TokyoTokyoJapan
  29. 29.Department of Obstetrics and GynecologyNiigata UniversityNiigataJapan
  30. 30.Department of Obstetrics and GynecologyOsaka Rosai HospitalOsakaJapan
  31. 31.Department of GynecologyShizuoka Cancer CenterShizuokaJapan
  32. 32.Department of Obstetrics and GynecologyKurashiki Medical CenterOkayamaJapan
  33. 33.Department of Obstetrics and GynecologyKawasaki Medical SchoolOkayamaJapan
  34. 34.Department of PathologyKawasaki Medical SchoolOkayamaJapan
  35. 35.Department of Obstetrics and GynecologyKitano HospitalOsakaJapan
  36. 36.Department of PathologyKitano HospitalOsakaJapan
  37. 37.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyOregon Health and Science UniversityPortlandUSA
  38. 38.Department of PathologyOregon Health and Science UniversityPortlandUSA
  39. 39.Department of Obstetrics and GynecologyIwate Medical UniversityMoriokaJapan
  40. 40.Department of PathologyIwate Medical UniversityMoriokaJapan
  41. 41.Department of Obstetrics and GynecologyTokushima UniversityTokushimaJapan
  42. 42.Department of Obstetrics and GynecologyAichi Medical UniversityAichiJapan

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