title: The impact of multi-modal therapy on survival for uterine carcinosarcomas.
abstract: OBJECTIVE
  To investigate treatment outcomes of patients with carcinosarcoma of the uterus and to identify parameters predictive of survival. Secondary objectives included (a) the assessment of treatment failures as a function of histologic subtypes and (b) the impact of the new FIGO staging classification system.
  
  
  METHODS
  This is a retrospective outcomes analysis of 121 patients diagnosed with primary carcinosarcoma of the uterus. Clinical, surgical and pathological data were reviewed and patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma. Survivorship curves were evaluated with the log-rank test and associations between events and variables with Cox proportional hazards model.
  
  
  RESULTS
  In the multivariate analyses for disease-specific survival (DSS) and disease-free survival (DFS), the only independent factors were FIGO stage, adjuvant chemotherapy after surgery and the presence of clear cell histology in the tumor. The 5-year DSS for stages I-II, III and IV was 59%, 22% and 9%, respectively. The administration of platin-based chemotherapy provided a significant benefit with regard to both DFS (OR=0.28; p=0.001) and DSS (OR=0.35; p=0.01). While radiotherapy (RT) appeared to control vaginal failures in all stages, pelvic RT did not impact DSS. Of importance, the epithelial component was the predominant histology in both the primary extrauterine metastases (94%) and the distant failure sites (82%).
  
  
  CONCLUSIONS
  This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systemic therapy in patients with both early and advanced stage disease.
authors.affiliation: Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, MD 20892, USA. gonzalej@mail.nih.gov
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez Bosquet
authors.forename: Shelby A
authors.initials: SA
authors.lastname: Terstriep
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: Monica
authors.initials: M
authors.lastname: Brown-Jones
authors.forename: Judith S
authors.initials: JS
authors.lastname: Kaur
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000628:therapy; D002296:Carcinosarcoma / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult