title: Tumor characteristics and survival outcomes of women with tamoxifen-related uterine carcinosarcoma.
abstract: OBJECTIVE
  To examine tumor characteristics and survival outcome of women with uterine carcinosarcoma who had a history of tamoxifen use.
  
  
  METHODS
  This is a multicenter retrospective study examining stage I-IV uterine carcinosarcoma cases based on history of tamoxifen use. Patient demographics, tumor characteristics, treatment pattern, and survival outcomes were compared between tamoxifen users and non-users.
  
  
  RESULTS
  Sixty-six cases of tamoxifen-related uterine carcinosarcoma were compared to 1009 cases with no history of tamoxifen use. Tamoxifen users were more likely to be older (mean age, 69 versus 64, P<0.001) and had a past history of malignancy (100% versus 12.7%, P<0.001). Tamoxifen-related uterine carcinosarcoma was significantly associated with a higher proportion of stage IA disease (48.4% versus 29.9%) and a lower risk of stage IVB disease (7.8% versus 16.0%) compared to tamoxifen-unrelated carcinosarcoma (P=0.034). Deep myometrial tumor invasion was less common in uterine carcinosarcoma related to tamoxifen use (28.3% versus 48.8%, P=0.002). On univariate analysis, tamoxifen use was not associated with progression-free survival (5-year rates 44.5% versus 46.8%, P=0.48) and disease-specific survival (64.0% versus 59.1%, P=0.39). After adjusting for age, past history of malignancy, stage, residual disease status at surgery, and postoperative treatment patterns, tamoxifen use was not associated with progression-free survival (adjusted-hazard ratio 0.86, 95% confidence interval 0.50 to 1.50, P=0.60) and disease-specific survival (adjusted-hazard ratio 0.68, 95% confidence interval 0.36 to 1.29, P=0.24).
  
  
  CONCLUSIONS
  Our study suggests that tamoxifen-related uterine carcinosarcoma may have favorable tumor characteristics but have comparable stage-specific survival outcomes compared to tamoxifen-unrelated uterine carcinosarcoma.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA. Electronic address: koji.matsuo@med.usc.edu.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, PA, USA.
authors.forename: Malcolm S
authors.initials: MS
authors.lastname: Ross
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Bush
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: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Blake
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Takano
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Baba
authors.affiliation: Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Satoh
authors.affiliation: Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Shida
authors.affiliation: Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan.
authors.forename: Sosuke
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan.
authors.forename: Takuhei
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: Department of Obstetrics and Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Takekuma
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeuchi
authors.affiliation: Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Iwasaki
authors.affiliation: Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Yanai
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA.
authors.forename: Merieme M
authors.initials: MM
authors.lastname: Klobocista
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA.
authors.forename: Marian S
authors.initials: MS
authors.lastname: Johnson
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Machida
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takahito M
authors.initials: TM
authors.lastname: Miyake
authors.affiliation: Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan.
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nagano
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA.
authors.forename: Tanja
authors.initials: T
authors.lastname: Pejovic
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA.
authors.forename: Mian Mk
authors.initials: MM
authors.lastname: Shahzad
authors.affiliation: The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA.
authors.forename: Dwight D
authors.initials: DD
authors.lastname: Im
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Omatsu
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Ueland
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, PA, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy; D002296:Carcinosarcoma / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D004965:Estrogen Antagonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013629:Tamoxifen / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology / Q000628:therapy
chemical_list: D004965:Estrogen Antagonists; D013629:Tamoxifen
keywords: Survival outcome; Tamoxifen; Uterine carcinosarcoma