title: Adjuvant radiation therapy in uterine carcinosarcoma: A population-based analysis of patient demographic and clinical characteristics, patterns of care and outcomes.
abstract: To examine clinical and demographic characteristics of a population-based cohort of patients with uterine carcinosarcoma (UCS), to assess access to treatment and survival patterns.
  
  
  
  Surveillance, Epidemiology and End Results database was queried for patients diagnosed in 1999-2010 and treated with surgery with or without adjuvant radiation therapy (aRT). The Kaplan-Meier method was used to estimate survival functions, and Cox proportional hazards regression - to analyze the effect of covariates on survival.
  
  
  
  2342 patients were eligible. African Americans presented with more advanced AJCC stages than other races (35.4% vs. 29.1%; p<0.01). African Americans vs. others, and women diagnosed in 1999-2004 vs. in 2005-2010, received aRT at a similar rate: 36.5% vs. 39.9% (p=NS), and 39.5% vs. 38.9% (p=NS), respectively. There was a trend towards higher aRT utilization among patients younger than 65 vs. older (41.4% vs. 37.5%; p<0.06). We observed better overall and cause-specific survival in the aRT group: 42 vs. 22 (p<0.0001) and 57 vs. 28months (p<0.0001), respectively. Black race, diagnosis in 1999-2004, advanced stage and age≥65years carried a higher risk of UCS death.
  
  
  
  We observed greater survival rate in the aRT group. African Americans were more likely to present with later stage disease and die of UCS than non-African Americans. Age and stage, but not race, influenced receipt of aRT. Patients treated more recently survived longer.
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Radiation Oncology, 525 East 68th Street, New York, NY 10065, United States. Electronic address: jum9091@nyp.org.
authors.forename: Julia
authors.initials: J
authors.lastname: Manzerova
authors.affiliation: The Feinstein Institute for Medical Research, Biostatistics Unit, 350 Community Drive, Manhasset, NY 11030, United States.
authors.forename: Cristina P
authors.initials: CP
authors.lastname: Sison
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Gynecologic Oncology, 525 East 68th Street, J-130, New York, NY 10065, United States.
authors.forename: Divya
authors.initials: D
authors.lastname: Gupta
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Gynecologic Oncology, 525 East 68th Street, J-130, New York, NY 10065, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Holcomb
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Gynecologic Oncology, 525 East 68th Street, J-130, New York, NY 10065, United States.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Caputo
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Radiation Oncology, 525 East 68th Street, New York, NY 10065, United States.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Radiation Oncology, 525 East 68th Street, New York, NY 10065, United States.
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Radiation Oncology, 525 East 68th Street, New York, NY 10065, United States.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002296:Carcinosarcoma / Q000208:ethnology / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D044465:White People / Q000706:statistics & numerical data
keywords: Adjuvant radiation; African American; MMMT; Racial disparity; Survival; Uterine carcinosarcoma