Format

Send to

Choose Destination
Gynecol Oncol. 2017 Apr;145(1):78-87. doi: 10.1016/j.ygyno.2017.02.001. Epub 2017 Feb 16.

Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma.

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA. Electronic address: koji.matsuo@med.usc.edu.
2
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
3
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA.
4
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA.
5
Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
6
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA.
7
The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA.
8
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA.
9
Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan.
10
Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan.
11
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA.
12
Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan.
13
Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan.
14
Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
15
Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
16
Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan.
17
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA.
18
Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan.
19
Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.
20
Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan.
21
Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
22
Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
23
Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan.
24
Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan.
25
Department of Obstetrics and Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
26
Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan.
27
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA.

Abstract

BACKGROUND:

To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

KEYWORDS:

Chemotherapy; Radiotherapy; Recurrence; Stage I; Survival outcome; Uterine carcinosarcoma

PMID:
28215838
DOI:
10.1016/j.ygyno.2017.02.001
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center