Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group

Harano, Kenichi; Hirakawa, Akihiro; Yunokawa, Mayu; Nakamura, Toshiaki; Nishikawa, Tadaaki; Aoki, Daisuke; Ito, Kimihiko; Itō, Kiyoshi; Nakanishi, Tōru; Susumu, Nobuyuki; Takehara, Kazuhiro; Watanabe, Yoh; Watari, Hidemichi; Saito, Toshiaki

doi:10.1007/s10147-015-0859-7

Cited by 50 publications

(52 citation statements)

References 15 publications

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“…The finding that removal of lymph nodes improves survival is in accordance with previous publications [2, 5, 6, 10]. In the largest study, Nemani et al [2] evaluated the role of lymph node dissection in 1,855 patients with stage I–III UCS using data from the Surveillance, Epidemiology, and End Results (SEER) program in the USA.…”

Section: Discussionsupporting

confidence: 74%

“…Some relatively small studies describe no benefit of LND [7, 8]. Several larger retrospective cohort studies describe an improved survival of patients on whom LND was performed [2, 9, 10]. This is in accordance with studies on other aggressive subtypes of endometrial cancer like high-grade endometrial and serous endometrial cancer.…”

Section: Introductionsupporting

confidence: 69%

“…A limitation of the studies mentioned above is that their findings were not corrected for adjuvant radio- and/or chemotherapy (CT) [2, 9, 10]. This may have influenced the findings, as adjuvant radiotherapy (RT), CT, and combined radiochemotherapy (RCT) may improve the survival of UCS patients [11-14].…”

Section: Introductionmentioning

confidence: 99%

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Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Versluis

Pielsticker

et al. 2018

Oncology

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Objective: Uterine carcinosarcoma is a rare, aggressive subtype of endometrial cancer. Treatment consists of hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy (LND). The survival benefit of LND in relation to adjuvant radio- and/or chemotherapy is unclear. We evaluated the impact of LND on survival in relation to adjuvant therapy in uterine carcinosarcoma. Methods: Retrospective data on 1,140 cases were combined from the Netherlands Cancer Registry (NCR) and the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). LND was defined as the removal of any nodes. Additionally, cases where 10 nodes or less (LND ≤10) or more than 10 nodes (LND > 10) were removed were analyzed separately. Adjuvant therapy was evaluated as radiotherapy, chemotherapy, or radiochemotherapy. Associations were analyzed by χ² test, log-rank test, and Cox regression analysis. Results: Overall survival (OS) had improved after total abdominal hysterectomy with bilateral salpingo-oophorectomy with LND > 10 (HR 0.62, 95% CI 0.47–0.83). Adjuvant therapy was related to OS with an HR of 0.64 (95% CI 0.54–0.75) for radiotherapy, an HR of 0.65 (95% CI 0.48–0.88) for chemotherapy, and an HR of 0.25 (95% CI 0.13–0.46) for radiochemotherapy. Additionally, adjuvant treatment was related to OS when lymph nodes were positive (HR 0.22, 95% CI 0.11–0.42), but not when they were negative. Conclusion: LND is related to improved survival when more than 10 nodes are removed. Adjuvant therapy improves survival when LND is omitted, or when nodes are positive.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionsupporting

confidence: 69%

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Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Versluis

Pielsticker

et al. 2018

Oncology

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“…Although the clinical and pathological features of UCS have been well described, the imaging findings, especially the ultrasonographic findings, have rarely been reported in the literature [2,3,5]. Therefore, in this retrospective study, we sought to obtain some useful ultrasonographic findings of UCS, which may aid in the early diagnosis of this disease.…”

Section: Introductionmentioning

confidence: 99%

“…Outcomes for patients with this histologic type of cancer are poor, as UCS has higher rates of recurrence and mortality than other high-grade endometrial cancers [2][3][4]. Stage, performance status, CA-125 level, lymph-vascular space involvement, and myometrial invasion are all associated with a poor prognosis [5,6]. Therefore, early diagnosis and treatment of UCS are important.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic Findings of Uterine Carcinosarcoma

Zhao

Zhang

et al. 2018

Gynecol Obstet Invest

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Aims: The aim of this study was to investigate the clinical features and ultrasonographic findings of uterine carcinosarcoma (UCS). Methods: Seventy-five patients (mean age, 58.6 years) with pathologically proven UCS who were treated at our hospital from January 2003 to December 2015 were retrospectively recruited. The clinical features and preoperative findings on transvaginal sonography (TVS) were investigated. Results: Eighty percent of the patients were postmenopausal. The primary symptoms were postmenopausal abnormal uterine bleeding (57.3%), irregular menstruation (18.7%), vaginal discharge (10.7%) and the presence of a uterine mass or others (13.3%). The tumor marker CA125 was evaluated in 43 women and was found to be elevated in 15 (34.9%); in 60% of those women (9/15), the CA125 level was lower than 200U/ml. According to the frequency of the different types of lesions observed by ultrasonic imaging, we decided to categorize the lesions into 3 different groups as follows: Group I, intrauterine tumors (73.33%); group II, intra-myometrial tumors (13.33%); and group III, intra-endometrial tumors (13.33 %). Conclusion: Combined with the clinical features, the characteristics demonstrated by TVS provide evidence for an indication of the presence of UCS and could contribute to clinical decision-making.

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Uterine carcinosarcoma: a primer for radiologists

et al. 2019

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Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group

Abstract: Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.

Cited by 50 publications

References 15 publications

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Ultrasonographic Findings of Uterine Carcinosarcoma

Uterine carcinosarcoma: a primer for radiologists

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