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Original Research

Open Access

Prognostic factors and adjuvant therapy in uterine carcinosarcoma

  • T.I. Wu1
  • K.H. Hsu2
  • H.J. Huang1
  • S. Hsueh3
  • H.H. Chou1
  • C.S. Tsai4
  • K.C. Ho5
  • A. Chao1
  • T.C. Chang1
  • C.H. Lai1,*,

1Department of Obstetrics and Gynecology, Taiwan

2Department of Health Care Management, Taiwan

3Department of Pathology, Taiwan

4Department of Radiation Oncology, Taiwan

5Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

DOI: 10.12892/ejgo200805483 Vol.29,Issue 5,September 2008 pp.483-488

Published: 10 September 2008

*Corresponding Author(s): C.H. Lai E-mail: sh46erry@ms6.hinet.net

Abstract

Purpose of investigation: The objective of this retrospective study was to investigate prognostic variables and impact of adjuvant therapy in uterine carcinosarcoma. Methods: The clinical information and pathological confirmation were reviewed for cases with uterine carcinosarcoma from 1984 to 2005. A total of 45 patients were eligible for analysis. Results: The median follow-up for survivors was 84 months. Five-year overall survival and progression-free survival (PFS) rates were 36.5% and 33.8%, respectively for Stage I-IV. Distant site metastasis with/without pelvic failure occurred in 83.3% of those with recurrence/progression. By multivariate analysis, older age (p = 0.001) and more than half of myometrial invasion (p = 0.002) were significant predictors of death, while only myometrial invasion (p = 0.022) was significantly associated with PFS. Stratified analyses demonstrated a monotonic trend of chemotherapy or chemoradiation to decrease death. Conclusions: Our results suggested that age and depth of myometrial invasion were significant prognostic factors, and chemotherapy or chemoradiation seemed to be beneficial for uterine carcinosarcoma.

Keywords

Uterine carcinosarcoma; Chemotherapy, Chemoradiation , Malignant mixed müllerian tumor, Prognostic factor

Cite and Share

T.I. Wu,K.H. Hsu,H.J. Huang,S. Hsueh,H.H. Chou,C.S. Tsai,K.C. Ho,A. Chao,T.C. Chang,C.H. Lai. Prognostic factors and adjuvant therapy in uterine carcinosarcoma. European Journal of Gynaecological Oncology. 2008. 29(5);483-488.

References

[1] Brooks S.E., Zhan M., Cote T., Baquet C.R.: “Surveillance, Epidemiology, and End Results analysis of 2677 cases of uterine sarcoma 1989-1999”. Gynecol. Oncol., 2004, 93, 204.

[2] Nordal R.R., Thoresen S.Ø.: “Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality”. Eur. J. Cancer, 1996, 33, 907.

[3] McCluggage W.G..: “Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas?”. J. Clin. Pathol., 2002, 55, 321.

[4] Silverberg S.G., Major F.J., Blessing J.A., Fetter B., Askin F.B., Liao S.Y. et al.: “Carcinosarcoma (MMMT) of the uterus: a GOG pathologic study of 203 cases”. Int. J. Gynecol. Pathol., 1990, 9, 1.

[5] Major F.J., Blessing J.A., Silverberg S.G., Morrow C.P., Creasman W.T., Currie J.L. et al.: “Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study”. Cancer, 1993, 71 (suppl.), 1702.

[6] Iwasa Y., Haga H., Konishi I., Kobashi Y., Higuchi K., Katsuyama E. et al.: “Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients”. Cancer, 1998, 82, 512.

[7] Yamada D.S., Burger R.A., Brewster W.R., Anton D., Kohler M.F., Monk B.J.: “Prognostic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus”. Cancer, 2000, 88, 2782.

[8] Sartori E., Bazzurini L., Gadducci A., Landoni F., Lissoni A., Maggino T. et al.: “Carcinosarcoma of the uterus: a clinicopathological multicenter CTF study”. Gynecol. Oncol., 1997, 67, 70.

[9] Amant F., Cadron I., Fuso L., Berteloot P., Jonge E., Jacomen G. et al.: “Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk endothelial endometrial cancer”. Gynecol. Oncol., 2005, 98, 274.

[10] Kanjeekal S., Chambers A., Fung M.F.K., Verma S.: “Systemic therapy for advanced uterine sarcoma: a systematic review of the literature”. Gynecol. Oncol., 2005, 97, 624.

[11] McCluggage W.G., Haller U., Kurman R.J.: “Mixed epithelial and mesenchymal tumours”. In: Tavassoli F.A., Decilee P. (eds.).World Health Organization Classification of Tumours. Pathology & Genetics of Tumours of the Breast and Female Genital Organs. Lyon, IARC Press, 2003, 245.

[12] SPSS for windows, Rel 11.0.1. Chicago, SPSS. Inc., 2001.

[13] SAS Statistical Package, Version 8.1. Cary, NC: SAS Institute, Inc., 2000.

[14] Gerszten K., Faul C., Kounelis S., Huang Q., Kelly J., Jones M.W.: “The impact of adjuvant radiotherapy on carcinosarcoma of the uterus”. Gynecol. Oncol., 1998, 68, 8.

[15] Callister M., Ramondetta L.M., Jhingran A., Burke T.W., Eifel P.J.: “Malignant mixed mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome”. Int. J. Radiat. Oncol. Biol. Phy., 2004, 58, 786.

[16] Manolitsas T.P.,Wain G.V.,Willians K.E., Freidlander M., Hacker N.F.: “Multimodality therapy for patients with clinical Stage I and II malignant mixed müllerian tumors of the uterus”. Cancer, 2001, 91, 1437.

[17] Menczer J., Levy T., Piura B., Chetrit A., Altaras M., Meirovitz M. et al.: “A comparison between different postoperative treatment modalities of uterine carcinosarcoma”. Gynecol. Oncol., 2005, 97, 166.

[18] Sutton G., Kauderer J., Carson L.F., Lentz S.S., Whitney C.W., Gallion H.: “Adjuvant ifosfamide and cisplatin in patients with completely resected Stage I or II carcinosarcomas (mixed mesodermal tumors) of the uterus: a Gynecologic Oncologic Group study”. Gynecol. Oncol., 2005, 96, 630.

[19] Wolfson A.H., Brady M.F., Mannel R.S., Lee Y., Futoran R.J., Cohn D. et al.: “A Gynecologic Oncology Group randomized trial of whole abdominal irradiation (WAI) vs cisplatinifosfamide+mesna (CIM) in optimally debulked Stage I-IV carcinosarcoma (CS) of the uterus”. Gynecol. Oncol., 2007, 107, 166.

[20] Omura G.A., Major F.J., Blessing J.A., Sedlacek T.V., Thigpen J.T., Creasman W.T. et al.: “A randomized study of adriamycin with and without dimethyl triazenoimidazole carboxamide in advanced uterine sarcomas”. Cancer, 1983, 52, 626.

[21] Sutton G., Brunetto V.L., Kilgore L., Soper J.T., McGehee R., Olt G. et al.: “A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group study”. Gynecol. Oncol., 2000, 79, 147.

[22] Homesley H.D., Filiaci V., Markman M., Bitterman P., Eaton L., Kilgore L.C. et al.: “Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2007, 25, 526.

[23] Miller D.S., Blessing J.A., Schilder J., Munkarah A., Lee Y.C.: “Phase II evaluation of topotecan in carcinosarcoma of the uterus: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2005, 98, 217.

[24] Carmen M.G., Fuller A.F., Matulonis U., Horick N.K., Goodman A., Duska L.R. et al.: “Phase II trial of anastrozole in women with asymptomatic müllerian cancer”. Gynecol. Oncol., 2003, 91, 596.

[25] Kuo D.Y.S., Timmins P., Blank S.V., Fields A.L., Goldberg G.L., Murgo A. et al.: “Phase II trial of thalidomide for advanced and recurrent gynecologic sarcoma: a brief communication from the New York phase II consortium”. Gynecol. Oncol., 2006, 100, 160.

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