title: Optimal cytoreductive surgery in patients with advanced uterine carcinosarcoma: A multi-institutional retrospective study from the Japanese gynecologic oncology group.
abstract: BACKGROUND
  The benefits of cytoreductive surgery for uterine carcinosarcoma (UCS) are unknown. The objective of this study was to determine the impact of optimal surgery on advanced UCS patient survival.
  
  
  METHODS
  We performed a multi-institutional, retrospective study of women diagnosed with stage IIIIV UCS between 2007 and 2012. Data were obtained retrospectively from medical records, including demographic, clinicopathologic, treatment, and outcome information. Optimal cytoreductive surgery was defined as surgery resulting in a maximum residual tumor of ≤1cm. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS), and the Cox regression model was used to examine the impact of selected factors on survival.
  
  
  RESULTS
  A total of 225 UCS patients (median age, 63years) were identified, including 136 (60%) with stage III and 89 (40%) with stage IV disease. Among these patients, 170 (76%) received optimal cytoreductive surgery. The median follow-up time was 19months. The median PFS was 11.5months (95% confidence interval [CI], 10.6-13.4) and 8.1months (95% CI, 5.1-9.5) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P<0.0001). The median OS was 37.9months (95% CI, 28.3-not reached) and 18months (95% CI, 9.6-21) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P<0.0001). Residual tumor >1cm was associated with worse OS while pelvic lymph node dissection was associated with improved OS.
  
  
  CONCLUSIONS
  Optimal cytoreductive surgery and pelvic lymph node dissection are associated with improved OS in advanced UCS patients.
authors.affiliation: Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan. Electronic address: 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; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Cytoreductive surgery; Pelvic lymph node dissection; Uterine carcinosarcoma