title: Radical surgical cytoreduction in the treatment of ovarian carcinosarcoma.
abstract: OBJECTIVE
  Carcinosarcomas are rare and aggressive ovarian malignancies. Treatment recommendations, which include surgical cytoreduction followed by platinum based chemotherapy, have been based on small amounts of retrospective data or extrapolated from experience with high-grade epithelial ovarian adenocarcinoma. Our objective was to determine the effects of radical primary cytoreduction on progression-free survival (PFS) and overall survival (OS).
  
  
  METHODS
  Following IRB approval, records of women with ovarian carcinosarcomas diagnosed between 2000 and 2012 at our institution were reviewed. Demographics, tumor characteristics, treatments, PFS, and OS were collected. Patients were divided into three groups based on the amount of residual disease: >1cm of disease, ≤ 1 cm of disease, or no visible disease. Chi-square and student's t-test were used to compare variables among groups. Kaplan-Meier survival curves were generated and compared with the log-rank test.
  
  
  RESULTS
  51 patients with ovarian carcinosarcoma were identified and all underwent primary cytoreductive surgery. Following surgical cytoreduction, 18 patients (35%) had no visible disease, 20 (39%) had ≤ 1 cm of disease, and 13 (25%) had >1cm of residual disease. Median PFS varied significantly among groups: 29 vs. 21 vs. 2 months (p=0.036) as did median OS: 57 vs. 32 vs. 11 months (p=0.015). When patients with stage 3 disease were analyzed separately, median OS still varied significantly among groups: 57 versus 31 versus 3 months (p=0.009).
  
  
  CONCLUSIONS
  Degree of surgical cytoreduction appears to correlate with PFS and OS. Radical surgery resulting in no visible disease is recommended for the upfront surgical treatment of ovarian carcinosarcoma.
authors.affiliation: University of Alabama at Birmingham School of Medicine, USA. Electronic address: david.doo@ucdenver.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Doo
authors.affiliation: University of Alabama at Birmingham, Division of Gynecologic Oncology, USA.
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.affiliation: University of Alabama at Birmingham, Division of Gynecologic Oncology, USA.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Arend
authors.affiliation: University of Alabama at Birmingham, Division of Anatomic Pathology, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Conner
authors.affiliation: University of Alabama at Birmingham, Division of Gynecologic Oncology, USA.
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.affiliation: University of Alabama at Birmingham, Division of Gynecologic Oncology, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000368:Aged; D002296:Carcinosarcoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003125:Colostomy; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008875:Middle Aged; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D010052:Ovariectomy; D010388:Pelvis; D010537:Peritoneum / Q000601:surgery; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D058994:Salpingectomy; D016896:Treatment Outcome
keywords: Optimal cytoreduction; Ovarian carcinosarcoma