title: The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma.
abstract: OBJECTIVE
  Uterine carcinosarcoma (CS) is a rare but aggressive malignancy frequently associated with extrauterine metastasis at the time of diagnosis. The objective of this study was to assess the role of cytoreductive surgery in patients with stage IIIC-IVB uterine CS.
  
  
  METHODS
  We conducted a retrospective review of all patients with uterine CS treated at our institution from 1990 to 2009. Clinicopathologic factors, surgical procedures, adjuvant therapy, and survival outcomes were collected for all patients. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Factors predictive of survival outcomes were compared using the log-rank test and Cox regression analysis.
  
  
  RESULTS
  An analysis of 44 patients was performed (stage IIIC, n=14; stage IVB, n=30). Complete gross resection was achieved in 57% of patients. PFS and OS for the entire cohort were 8.6 months and 18.5 months, respectively. Complete gross resection was associated with a median OS of 52.3 months versus 8.6 months in patients with gross residual disease (P<0.0001). Stage IIIC disease was associated with a median OS of 52.3 months versus 17.5 months for patients with stage IVB disease. In patients who received adjuvant therapy, OS was 30.1 months versus 4.7 months in patients who did not receive adjuvant therapy (P<0.001). On multivariate analysis, only complete gross resection and the ability to receive adjuvant therapy were independently associated with OS.
  
  
  CONCLUSIONS
  Cytoreductive surgery, with a goal of achieving a complete gross resection, is associated with an improvement in OS among patients with advanced uterine CS.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10068, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Tanner
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.forename: Karuna
authors.initials: K
authors.lastname: Garg
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010052:Ovariectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D058994:Salpingectomy