A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma.
OBJECTIVE
To evaluate the use of adjuvant therapy after primary surgery for stage I-III uterine carcinosarcoma (CS).


METHODS
A multi-institutional retrospective study of women with stage I-III CS was conducted. Analyses were stratified by stage (I/II and III). Patients were categorized according to adjuvant therapy: observation (OBS), radiation (RT), chemotherapy (CT) or multimodal therapy (CT+RT). Overall survival (OS) and progression-free survival (PFS) were analyzed using log-rank tests and Cox proportional hazards models.


RESULTS
303 patients were identified across four institutions: 195 with stage I/II and 108 with stage III disease. In stage I/II disease, 75 (39.9%) received OBS, 33 (17.6%) CT, 37 (19.7%) RT, and 43 (22.9%) CT+RT. OBS was associated with a fourfold increased risk of death compared to CT (adjusted hazard ratio (aHR)=4.48, p=0.003). Patients receiving CT+RT had significantly improved PFS compared to those receiving CT alone (aHR=0.43, p=0.04), but no difference in OS. In the stage III cohort, 16 (15.0%) received OBS, 34 (31.8%) CT, 20 (18.7%) RT, and 37 (34.6%) CT+RT. OBS was associated with worse OS and PFS compared to CT (OS: aHR=2.46, p=0.04; PFS: aHR=2.39, p=0.03, respectively). A potential improvement in PFS was seen for those treated with CT+RT compared to CT alone, however it was not statistically significant (aHR=0.53, p=0.09).


CONCLUSIONS
Observation after surgery was associated with poor outcomes in uterine CS compared to CT and RT alone. Multimodality therapy for women with stage I/II disease was associated with improved PFS compared to chemotherapy alone. Novel treatment options are needed to improve outcomes in this aggressive disease.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, United States.
Elizabeth L
EL
Dickson
Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, United States.
Rachel Isaksson
RI
Vogel
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina, United States.
Paola A
PA
Gehrig
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina, United States.
Stuart
S
Pierce
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University, United States.
Laura
L
Havrilesky
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University, United States.
Angeles Alvarez
AA
Secord
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University, United States.
Joseph
J
Dottino
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, United States.
Amanda N
AN
Fader
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, United States.
Stephanie
S
Ricci
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, United States. Electronic address: gelle005@umn.edu.
Melissa A
MA
Geller
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002296:Carcinosarcoma / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007069:Ifosfamide / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*
D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide
Chemotherapy; MMMT; Multimodal therapy; Radiation; Survival; Uterine carcinosarcoma