Role of surgical staging and adjuvant chemotherapy in the treatment of uterine carcinosarcoma
Cabrera O, Cho C, Dalmar A, et al. Role of surgical staging and adjuvant chemotherapy in the treatment of uterine carcinosarcoma. Gynecologic Oncology. 2015; 137(Suppl 1):96-97.
Objectives: To determine the clinical behavior and role of chemotherapy and surgical staging in the management of patients with carcinosarcoma of the uterus.
Methods: A retrospective study of patients with carcinosarcoma of the uterus treated at a single institution from 2002 to 2013 was included in the analysis. Kaplan–Meier curves were used to illustrate progression-free (PFS) and overall survival (OS) comparing administration of adjuvant chemotherapy, FIGO staging, and performance of lymphadenectomy. Cox's proportional hazard model was used to evaluate PFS and OS, controlling for age, race, lymphadenectomy, and laparotomy.
Results: Sixty-seven patients aged 71 ± 11.3 years who were diagnosed with uterine carcinosarcoma (35 stage I, 2 stage II, 22 stage III, and 5 stage IV) and had a median follow-up of 13.8 months were included in the study. Of 42 patients who received chemotherapy, seven were never disease-free. Of the 35 patients with no residual disease after surgery who received adjuvant chemotherapy, 16 developed recurrences and 10 subsequently died of their diseases. Of 25 patients who did not receive chemotherapy, three were never disease-free. Of 22 patients who had no residual disease after surgery and did not receive chemotherapy, 14 recurred and six died of their disease. The 5-year OS and PFS rates for the adjuvant chemotherapy group were 34.6% and 20.7%, respectively, compared to 7.7% and 4.8% in those without chemotherapy (P = 0.11, OS; P = 0.02, PFS). Patients with FIGO stage I had significant better PFS (P = 0.013) and OS (P b 0.01). Advanced age (P = 0.04) and patients who received laparotomy (HR = 3.0, 95% CI 1.25–7.21) and no lymphadenectomy (HR = 3.39, 95% CI: 1.25–9.09) were associated with increased hazard of recurrence. In addition, advanced age (P b 0.01) and patients with laparotomy (HR = 3.11, 95% CI: 1.22–7.92) were associated with decreased OS.
Conclusions: Adjuvant chemotherapy may reduce recurrences and improve PFS in patients with uterine carcinosarcoma.