title: Patterns of care, predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: a population-based analysis.
abstract: OBJECTIVE
  To examine the patterns of care, predictors, and impact of chemotherapy on survival in elderly women diagnosed with early-stage uterine carcinosarcoma.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify women 65 years or older diagnosed with stage I-II uterine carcinosarcomas from 1991 through 2007. Multivariable logistic regression and Cox-proportional hazards models were used for statistical analysis.
  
  
  RESULTS
  A total of 462 women met the eligibility criteria; 374 had stage I, and 88 had stage II uterine carcinosarcomas. There were no appreciable differences over time in the percentages of women administered chemotherapy for early stage uterine carcinosarcoma (14.7% in 1991-1995, 14.9% in 1996-2000, and 17.9% in 2001-2007, P=0.67). On multivariable analysis, the factors positively associated with receipt of chemotherapy were younger age at diagnosis, higher disease stage, residence in the eastern part of the United States, and lack of administration of external beam radiation (P<0.05). In the adjusted Cox-proportional hazards regression models, administration of three or more cycles of chemotherapy did not reduce the risk of death in stage I patients (HR: 1.45, 95% CI: 0.83-2.39) but was associated with non-significant decreased mortality in stage II patients (HR: 0.83, 95% CI: 0.32-1.95).
  
  
  CONCLUSIONS
  Approximately 15-18% of elderly patients diagnosed with early-stage uterine carcinosarcoma were treated with chemotherapy. This trend remained stable over time, and chemotherapy was not associated with any significant survival benefit in this patient population.
authors.affiliation: Division of Gynecologic Oncology, Washington University School of Medicine., Siteman Cancer Center, St. Louis, MO, USA. Electronic address: gunjalgarg@yahoo.com.
authors.forename: Gunjal
authors.initials: G
authors.lastname: Garg
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Yee
authors.affiliation: Department of Family Medicine, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.affiliation: Division of Gynecologic Oncology, Washington University School of Medicine., Siteman Cancer Center, St. Louis, MO, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.affiliation: Division of Gynecologic Oncology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, MI, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
authors.affiliation: Division of Gynecologic Oncology, Washington University School of Medicine., Siteman Cancer Center, St. Louis, MO, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016015:Logistic Models; D008197:Lymph Node Excision; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010388:Pelvis; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology
keywords: Carcinosarcoma; Chemotherapy; Outcomes; Patterns of care