title: Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma.
abstract: To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma.
  
  
  
  A multicenter retrospective study was conducted to examine uterine carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes.
  
  
  
  Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001).
  
  
  
  Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA koji.matsuo@med.usc.edu.
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authors.affiliation: Department of Pathology, Cancer Institute Hospital, Tokyo, Japan.
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authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology.
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mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D002296:Carcinosarcoma / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007069:Ifosfamide; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy
chemical_list: D007069:Ifosfamide
keywords: carcinoma; chemotherapy; histology; sarcoma; survival outcome; uterine carcinosarcoma