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Ann Surg Oncol. 2018 Nov;25(12):3676-3684. doi: 10.1245/s10434-018-6695-z. Epub 2018 Aug 13.

Proposal for a Risk-Based Categorization of Uterine Carcinosarcoma.

Author information

1
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. koji.matsuo@med.usc.edu.
2
Department of Pathology, Cancer Institute Hospital, Tokyo, Japan.
3
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
4
Department of Pathology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA.
5
Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
6
Department of Pathology, Mercy Medical Center, Baltimore, MD, USA.
7
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
8
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Montefiore Medical Center, New York City, NY, USA.
9
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA.
10
Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan.
11
Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan.
12
Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan.
13
Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.
14
Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.
15
Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan.
16
Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan.
17
Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan.
18
Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan.
19
Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan.
20
Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan.
21
Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan.
22
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington, KY, USA.
23
Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.
24
Department of Pathology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
25
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
26
Department of Pathology, University of Southern California, Los Angeles, CA, USA.
27
Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan.
28
Department of Pathology, Tokai University, Kanagawa, Japan.
29
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan.
30
Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan.
31
Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan.
32
Department of Pathology, Kawasaki Medical School, Okayama, Japan.
33
Department of Pathology, Kitano Hospital, Osaka, Japan.
34
Department of Pathology, Oregon Health and Science University, Portland, OR, USA.
35
Department of Pathology, Iwate Medical University, Morioka, Japan.
36
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
37
Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan.
38
Department of Pathology, The University of Tokyo, Tokyo, Japan.
39
Department of Pathology, University of Colorado, Denver, CO, USA.
40
Department of Gynecology, Mercy Medical Center, Baltimore, MD, USA.
41
Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
42
Department of Pathology, University of Kentucky Medical Center, Lexington, KY, USA.
43
Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, NY, USA.

Abstract

PURPOSE:

To propose a categorization model of uterine carcinosarcoma (UCS) based on tumor cell types (carcinoma and sarcoma) and sarcoma dominance.

METHODS:

This secondary analysis of a prior multicenter retrospective study examined 889 cases of UCS with available histologic evaluation. Based on survival outcome, cases were clustered into three groups: low-grade carcinoma with nondominant homologous sarcoma [type A, n = 96 (10.8%)], (1) low-grade carcinoma with heterologous sarcoma or any sarcoma dominance and (2) high-grade carcinoma with nondominant homologous sarcoma [type B, n = 412 (46.3%)], and high-grade carcinoma with heterologous sarcoma or any sarcoma dominance [type C, n = 381 (42.9%)]. Tumor characteristics and outcome were examined based on the categorization.

RESULTS:

Women in type C category were more likely to be older, obese, and Caucasian, whereas those in type A category were younger, less obese, Asian, and nulligravid (all P < 0.01). Type C tumors were more likely to have metastatic implants, large tumor size, lymphovascular space invasion with sarcoma cells, and higher lymph node ratio, whereas type A tumors were more likely to be early-stage disease and small (all P < 0.05). On multivariate analysis, tumor categorization was independently associated with progression-free survival (5-year rates: 70.1% for type A, 48.3% for type B, and 35.9% for type C, adjusted P < 0.01) and cause-specific survival (5-year rates: 82.8% for type A, 63.0% for type B, and 47.1% for type C, adjusted P < 0.01).

CONCLUSION:

Characteristic differences in clinicopathological factors and outcomes in UCS imply that different underlying etiologies and biological behaviors may be present, supporting a new classification system.

PMID:
30105438
DOI:
10.1245/s10434-018-6695-z
[Indexed for MEDLINE]

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