A Multi-institutional Study of Outcomes in Stage I-III Uterine Carcinosarcoma

Overview

Journal Gynecol Oncol

Date 2015 Sep 9

PMID 26348313

Citations 6

Authors

Elizabeth L Dickson

Rachel Isaksson Vogel

Paola A Gehrig

Stuart Pierce

Laura Havrilesky

Angeles Alvarez Secord

Joseph Dottino

Amanda N Fader

Stephanie Ricci

Melissa A Geller

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the use of adjuvant therapy after primary surgery for stage I-III uterine carcinosarcoma (CS).

Methods: A multi-institutional retrospective study of women with stage I-III CS was conducted. Analyses were stratified by stage (I/II and III). Patients were categorized according to adjuvant therapy: observation (OBS), radiation (RT), chemotherapy (CT) or multimodal therapy (CT+RT). Overall survival (OS) and progression-free survival (PFS) were analyzed using log-rank tests and Cox proportional hazards models.

Results: 303 patients were identified across four institutions: 195 with stage I/II and 108 with stage III disease. In stage I/II disease, 75 (39.9%) received OBS, 33 (17.6%) CT, 37 (19.7%) RT, and 43 (22.9%) CT+RT. OBS was associated with a fourfold increased risk of death compared to CT (adjusted hazard ratio (aHR)=4.48, p=0.003). Patients receiving CT+RT had significantly improved PFS compared to those receiving CT alone (aHR=0.43, p=0.04), but no difference in OS. In the stage III cohort, 16 (15.0%) received OBS, 34 (31.8%) CT, 20 (18.7%) RT, and 37 (34.6%) CT+RT. OBS was associated with worse OS and PFS compared to CT (OS: aHR=2.46, p=0.04; PFS: aHR=2.39, p=0.03, respectively). A potential improvement in PFS was seen for those treated with CT+RT compared to CT alone, however it was not statistically significant (aHR=0.53, p=0.09).

Conclusions: Observation after surgery was associated with poor outcomes in uterine CS compared to CT and RT alone. Multimodality therapy for women with stage I/II disease was associated with improved PFS compared to chemotherapy alone. Novel treatment options are needed to improve outcomes in this aggressive disease.

Citing Articles

Uterine carcinosarcoma: A 10-year single institution experience.

Terblanche L, Botha M PLoS One. 2022; 17(7):e0271526.

PMID: 35862371 PMC: 9302809. DOI: 10.1371/journal.pone.0271526.

Patterns of adjuvant treatment and survival outcomes in stage I uterine carcinosarcoma.

Cory L, Brensinger C, Burger R, Giuntoli 2nd R, Morgan M, Latif N Gynecol Oncol Rep. 2022; 39:100930.

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Beckmann K, Selva-Nayagam S, Olver I, Miller C, Buckley E, Powell K Cancer Manag Res. 2021; 13:4633-4645.

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Adjuvant chemotherapy in endometrial cancer.

Gomez-Raposo C, Merino Salvador M, Aguayo Zamora C, Casado Saenz E Cancer Chemother Pharmacol. 2020; 85(3):477-486.

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Mills K, Lopez H, Sun L, Cripe J, Litz T, Thaker P Gynecol Oncol Rep. 2019; 29:20-24.

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