title: Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group.
abstract: BACKGROUND
  Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known.
  
  
  METHODS
  We performed a multi-institutional, retrospective study of women with stage I-IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information.
  
  
  RESULTS
  A total of 486 patients (median age 65 years) were identified-224 (46 %) were stage I, 32 (7 %) were stage II, 139 (28 %) were stage III, and 91 (19 %) were stage IV. Among them, 277 (57 %) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 % confidence interval (CI) 15.7-27.2], and median overall survival (OS) was 72.0 months (95 % CI 43.0-not reached). In total, 454 (94 %) patients received adjuvant treatment, and 440 (91 %) received adjuvant chemotherapy. In multivariate analysis, stage III-IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III-IV disease, performance status 2-4, ≥50 % myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS.
  
  
  CONCLUSIONS
  Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.
authors.affiliation: Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-0063, Japan. haranokenichi@gmail.com.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Harano
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirakawa
authors.affiliation: Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Mayu
authors.initials: M
authors.lastname: Yunokawa
authors.affiliation: Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Toyomi
authors.initials: T
authors.lastname: Satoh
authors.affiliation: Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Aoki
authors.affiliation: Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Amagasaki, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Disaster Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Gynecology, Aichi Cancer Center, Nagoya, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Susumu
authors.affiliation: Department of Gynecologic Oncology, Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takehara
authors.affiliation: Department of Clinical Research Network, Clinical Research Innovation and Education Center, Tohoku University Hospital, Sendai, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Watari
authors.affiliation: Department of Gynecology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D018394:CA-125 Antigen / Q000097:blood; D002296:Carcinosarcoma / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology; D009215:Myometrium / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010388:Pelvis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D014594:Uterine Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy*
chemical_list: D018394:CA-125 Antigen
keywords: Lymphadenectomy; Pelvic lymph node; Prognostic factor; Uterine carcinosarcoma