title: Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma.
abstract: To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern.
  
  
  
  We examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns.
  
  
  
  The most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27-0.62, P<0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13-1.58, P=0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P<0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02-0.90; P=0.013) but not in none/single factor (P=0.36).
  
  
  
  Adjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.
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: 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, 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, University of Kentucky, KY, USA.
authors.forename: Marian S
authors.initials: MS
authors.lastname: Johnson
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, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA.
authors.forename: Merieme M
authors.initials: MM
authors.lastname: Klobocista
authors.affiliation: The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA.
authors.forename: Dwight D
authors.initials: DD
authors.lastname: Im
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 Obstetrics and Gynecology, Osaka University, Osaka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Takano
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, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Hasegawa
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, Tokai University, Kanagawa, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Shida
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, Osaka Rosai Hospital, Osaka, Japan.
authors.forename: Takuhei
authors.initials: T
authors.lastname: Yokoyama
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, Niigata University, Niigata, Japan.
authors.forename: Sosuke
authors.initials: S
authors.lastname: Adachi
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, Aichi Medical University, Aichi, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Iwasaki
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, Kurashiki Medical Center, Okayama, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Yanai
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, Kitano Hospital, Osaka, Japan.
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nagano
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, Iwate, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeuchi
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: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, 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: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D002296:Carcinosarcoma / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: Chemotherapy; Radiotherapy; Recurrence; Stage I; Survival outcome; Uterine carcinosarcoma