Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment

Abstract

Background Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit, using multi-institutional clinical registry data from South Australia. Methods Data for all consecutive cases of UCS from 1980 to 2019 were extracted from the Clinical Cancer Registry. Clinical and treatment-related factors associated with disease-specific mortality (DSM) and all-cause mortality (ACM) were determined using multivariable Cox proportional hazards regression, with subgroup analyses by stage. Results Median follow-up for the 140 eligible cases was 21 months. 94% underwent hysterectomy, and 72% had an additional pelvic lymph node dissection (PLND). Furthermore, 16% received adjuvant chemotherapy; 11% adjuvant radiotherapy and 16% multimodal chemoradiotherapy, with an increase in the latter two modalities over time. DSM was reduced among those who underwent PLND (HR: 0.41; 95%CI: 0.23–0.74), adjuvant chemotherapy (HR: 0.39; 95%CI: 0.18–0.84) or multimodality treatment (HR: 0.11; 95%CI: 0.06–0.30) compared with hysterectomy alone for the whole cohort and for late stage disease (FIGO III/IV) but not for earlier stage disease, except for reduced DSM with multimodal therapy. Findings were similar for ACM. Conclusion Our findings indicate better survival among those who received PLND, chemotherapy and multimodal adjuvant therapy, with the latter applying to early and late stage disease. However, cautious interpretation is warranted, due to potential “indication bias” and limited power. Further research into effective treatment modalities, ideally using prospective study designs, is needed.

Exploring biomarkers and prognostic factors in uterine carcinosarcoma: An insight into L1CAM, CDX2, p53, and MSI status

“…The proportion of cases diagnosed at advanced stages was considerable, with some patients having metastases detected only during or after surgery. The rates of omentectomy and lymphadenectomy in our cohort were also consistent with previously reported series [ 42 – 44 ].…”

Malignant mixed mullerian tumors: a SEER database review of rurality and treatment modalities on disease outcome

“…The use of adjuvant chemotherapy and radiation therapy has both increased over time and improved the OS of patients with MMMTs ( 7 ). A study of older MMMT patients did not find sufficient data to suggest restricting adjuvant radiation (p = 0.28) or chemotherapy (p = 0.61) as further treatment options, even in late-stage disease ( 36 , 37 ). Similarly, the present examination found adjuvant chemotherapy and radiation to both individually offer a survival benefit.…”

Target Volume Determination for Recurrent Uterine Carcinosarcoma: An Original Research Article Revisiting the Utility of Multimodality Imaging

“…Even though uterine sarcomas may be considered as relatively more uncommon tumors presenting as biphasic neoplasms including admixed epithelial and mesenchymal elements, they may lead to uterine cancer specific mortality [1][2][3][4][5]. Divergence and metaplasia of carcinomatous components into sarcomatous components may occur in consistentency with the conversion theory [1].…”