Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years

Surg Oncol. 2019 Jun:29:25-32. doi: 10.1016/j.suronc.2019.02.002. Epub 2019 Feb 7.

Abstract

Objective: To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years.

Methods: This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I-IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 (n = 82 [9.1%]), aged 60-79, (n = 526 [58.1%]), and aged <60 (n = 298 [32.9%]).

Results: Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group (P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60-79 group (HR 0.97, 95%CI 0.51-1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60-79 group (HR 1.62, 95%CI 1.09-2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy.

Conclusion: Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group.

Keywords: Adjuvant therapy; Elderly; Oldest old; Surgery; Survival; Uterine carcinosarcoma.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinosarcoma / mortality
  • Carcinosarcoma / pathology*
  • Carcinosarcoma / therapy
  • Chemotherapy, Adjuvant / mortality*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy / mortality*
  • Lymph Node Excision / mortality*
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Prognosis
  • Radiotherapy, Adjuvant / mortality*
  • Retrospective Studies
  • Survival Rate
  • Uterine Neoplasms / mortality
  • Uterine Neoplasms / pathology*
  • Uterine Neoplasms / therapy