title: Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior.
abstract: OBJECTIVE
  To compare the clinical behavior and outcome of uterine carcinosarcomas and grade 3 endometrioid carcinomas.
  
  
  METHODS
  Data on patients with grade 3 endometrioid adenocarcinomas and uterine carcinosarcomas, from 1988 to 2004, was obtained from the Surveillance, Epidemiology, and End Results database. Mortality was analyzed using Cox proportional hazards models. Survival analysis was performed with the Kaplan-Meier method and log rank test.
  
  
  RESULTS
  The cohort included 8,986 women with 5,024 (56%) grade 3 endometrioid carcinomas and 3,962 (44%) uterine carcinosarcomas. Women with uterine carcinosarcomas were older (aged 70 years compared with 66 years; P<.001) and more often nonwhite (23% compared with 15%; P<.001). These women presented with more advanced disease (stage III/IV 41% compared with 31%; P<.001). Multivariable analysis demonstrated that uterine carcinosarcoma histology, advanced age, nonwhite race, and advanced stage were independent predictors of poor survival. Cancer-specific mortality was 45% lower in women with grade 3 endometrioid carcinomas (hazard ratio 0.55; 95% confidence interval [CI] 0.5-0.6). The 5-year cancer-specific survival was lower for women with uterine carcinosarcoma for each disease stage. Survival for stage IC was 38% (95% CI 33-45%) for uterine carcinosarcoma compared with 68% (95% CI 63-73%) for grade 3 endometrioid carcinoma. For stage III, survival was 22% (95% CI 19-26%) for uterine carcinosarcoma compared with 45% (95% CI 41-49%) for grade 3 endometrioid carcinoma.
  
  
  CONCLUSIONS
  Carcinosarcomas present at more advanced stage and have worse survival than grade 3 endometrioid carcinomas. Carcinosarcomas may represent a distinct biologic entity.
  
  
  METHODS
  II.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Venkatraman E
authors.initials: VE
authors.lastname: Seshan
authors.forename: Peter B
authors.initials: PB
authors.lastname: Schiff
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Carmel J
authors.initials: CJ
authors.lastname: Cohen
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000473:pathology; D002296:Carcinosarcoma / Q000401:mortality* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology