title: Survival of women with Mullerian adenosarcoma: A National Cancer Data Base study.
abstract: OBJECTIVE
  To determine overall survival (OS) and factors associated with OS of women with Mullerian adenosarcoma.
  
  
  METHODS
  Women with adenosarcoma of the uterus, cervix or ovary (n=2205) were identified from the 1998-2011 National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. A subset analysis of women with uterine adenosarcoma was also performed. Analyzed confounders included age, insurance status, income, race, surgical margin status, nodal and distant metastasis, surgical procedure type, and treatment with radiation and/or chemotherapy.
  
  
  RESULTS
  Primary sites were uterus (n=1884), cervix (n=229) and ovary (n=92), representing 0.43% of uterine, 0.16% of cervical, and 0.04% of ovarian cancers in the NCDB. Only 36/1176 (3.1%) and 2.5% (33/1,342) had nodal and/or distant metastasis, respectively, at diagnosis. Distant metastasis, positive surgical margin, increased age, higher composite comorbidity score and adjuvant radiotherapy were independently associated with decreased OS. Primary site, lymph node status, surgical procedure, chemotherapy use, race, insurance status and income quartiles were not significantly associated with OS. Each 1cm increase in tumor size was associated with increased hazard for death (HR (95% CI) 1.06 (1.01-1.12), p=0.018) among women with uterine adenosarcoma.
  
  
  CONCLUSIONS
  Complete surgical resection remains the only treatment with well-evidenced OS benefit among women with Mullerian adenosarcoma. Early surgical resection may increase survival of Mullerian adenosarcoma.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. Electronic address: brandon.seagle@northwestern.edu.
authors: Brandon-Luke L
authors: BL
authors: Seagle
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors: Margaux
authors: M
authors: Kanis
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors: Anna E
authors: AE
authors: Strohl
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States.
authors: Shohreh
authors: S
authors: Shahabi
mesh_terms: D018195:Adenosarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D000072662:Margins of Excision; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010052:Ovariectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D058994:Salpingectomy; D015996:Survival Rate; D047368:Tumor Burden; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D055815:Young Adult
keywords: Adenosarcoma; Cervix; Ovary; Prognosis; Survival; Uterus