1. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group
- Author
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Toru Nakanishi, Toshiaki Nakamura, Kazuhiro Takehara, Daisuke Aoki, Yoh Watanabe, Mayu Yunokawa, Kenichi Harano, Akihiro Hirakawa, Nobuyuki Susumu, Hidemichi Watari, Tadaaki Nishikawa, Toshiaki Saito, Toyomi Satoh, Kiyoshi Ito, and Kimihiko Ito
- Subjects
Oncology ,Neoplasm, Residual ,medicine.medical_treatment ,0302 clinical medicine ,Carcinosarcoma ,Japan ,Surgical oncology ,Medicine ,Stage (cooking) ,Lymph node ,Aged, 80 and over ,Muscle Neoplasms ,030219 obstetrics & reproductive medicine ,Hematology ,General Medicine ,Middle Aged ,Tumor Burden ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Uterine Neoplasms ,Myometrium ,Female ,Adult ,medicine.medical_specialty ,Gynecologic oncology ,Disease-Free Survival ,Pelvis ,03 medical and health sciences ,Internal medicine ,Humans ,Neoplasm Invasiveness ,Aged ,Neoplasm Staging ,Retrospective Studies ,Performance status ,business.industry ,Retrospective cohort study ,Confidence interval ,CA-125 Antigen ,Blood Vessels ,Lymph Node Excision ,Surgery ,Lymphadenectomy ,Lymph Nodes ,Neoplasm Recurrence, Local ,business - Abstract
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.
- Published
- 2015