title: Predictive and Prognostic Factors in Ovarian and Uterine Carcinosarcomas.
abstract: BACKGROUND
  Prognostic factors and the standard treatment approach for gynaecological carcinosarcomas have not yet been clearly defined. Although carcinosarcomas are more aggressive than pure epithelial tumours, they are treated similarly. Serous/clear cell and endometrioid components may be predictive factors for the efficacy of adjuvant chemotherapy (CT) or radiotherapy (RT) or RT in patients with uterine and ovarian carcinosarcomas. Heterologous carcinosarcomas may benefit more from adjuvant CT.
  
  
  OBJECTIVE
  We aimed to define the prognostic and predictive factors associated with treatment options in ovarian (OCS) and uterine carcinosarcoma (UCS).
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients with ovarian and uterine carcinosarcoma from 2000 to 2013, and 127 women were included in this study (24 ovarian and 103 uterine). Patients admitted to seventeen oncology centres in Turkey between 2000 and December 2013 with a histologically proven diagnosis of uterine carcinosarcoma with FIGO 2009 stage I-III and patients with sufficient data obtained from well-kept medical records were included in this study. Stage IV tumours were excluded. The patient records were retrospectively reviewed. Data from 104 patients were evaluated for this study.
  
  
  RESULTS
  Age (≥70 years) was a poor prognostic factor for UCS (p=0.036). Pelvic±para aortic lymph node dissection did not affect overall survival (OS) (p=0.35). Macroscopic residual disease was related with OS (p<0.01). The median OS was significantly longer in stage I-II patients than stage III patients (p=0.03). Adjuvant treatment improved OS (p=0.013). Adjuvant radiotherapy tended to increase the median OS (p=0.075). However, this tendency was observed in UCS (p=0.08) rather than OCS (p=0.6).Adjuvant chemotherapy had no effect on OS (p=0.15).Adjuvant radiotherapy significantly prolonged the median OS in patients with endometrioid component (p=0.034). A serous/clear cell component was a negative prognostic factor (p=0.035). Patients with serous/clear cell histology for whom adjuvant chemotherapy was applied had significantly longer OS (p=0.019), and there was no beneficial effect of adjuvant radiotherapy (p=0.4). Adjuvant chemotherapy was effective in heterologous tumours (p=0.026). In multivariate analysis, the stage and chemotherapy were prognostic factors for all patients. Age was an independent prognostic factor for UCS. However, serous/clear cell histology and radiotherapy tended to be significant prognostic factors.
  
  
  CONCLUSIONS
  The primary location, the histological type of sarcomatous and the epithelial component may be predictive factors for the efficacy of chemotherapy or radiotherapy in UCS and OCS.
authors.affiliation: Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: İrfan
authors.initials: İ
authors.lastname: Cicin
authors.affiliation: Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Tahsin
authors.initials: T
authors.lastname: Özatlı
authors.affiliation: Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: Esma
authors.initials: E
authors.lastname: Türkmen
authors.affiliation: Department of Medical Oncology, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
authors.forename: Türkan
authors.initials: T
authors.lastname: Özturk
authors.affiliation: Department of Medical Oncology, Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey.
authors.forename: Melike
authors.initials: M
authors.lastname: Özçelik
authors.affiliation: Department of Medical Oncology, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Devrim
authors.initials: D
authors.lastname: Çabuk
authors.affiliation: Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Gökdurnalı
authors.affiliation: Department of Medical Oncology, Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Balvan
authors.affiliation: Department of Medical Oncology, Atatürk Research and Training Hospital, İzmir, Turkey.
authors.forename: Yaşar
authors.initials: Y
authors.lastname: Yıldız
authors.affiliation: Department of Medical Oncology, Cumhuriyet University School of Medicine, Sivas, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Şeker
authors.affiliation: Department of Medical Oncology, Ankara Numune Research and Training Hospital, Ankara, Turkey.
authors.forename: Nuriye
authors.initials: N
authors.lastname: Özdemir
authors.affiliation: Department of Medical Oncology, Pamukkale University School of Medicine, Denizli, Turkey.
authors.forename: Burcu
authors.initials: B
authors.lastname: Yapar
authors.affiliation: Department of Medical Oncology, Muğla University School of Medicine, Muğla, Turkey.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Tanrıverdi
authors.affiliation: Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Günaydin
authors.affiliation: Department of Medical Oncology, Celal Bayar University School of Medicine, Manisa, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Menekşe
authors.affiliation: Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Öksüzoğlu
authors.affiliation: Department of Medical Oncology, İnönü University School of Medicine, Malatya, Turkey.
authors.forename: Asude
authors.initials: A
authors.lastname: Aksoy
authors.affiliation: Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Erdogan
authors.affiliation: Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Bekir Hacıoglu
authors.affiliation: Department of Medical Oncology, Sakarya Research and Training Hospital, Sakarya, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Arpaci
authors.affiliation: Department of Medical Oncology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Sevinç
keywords: Carcinosarcoma; ovary; predictive factors; prognostic factors; uterine