A multi-institutional study of outcomes in stage I-III uterine carcinosarcorna

作者：Dickson Elizabeth L; Vogel Rachel Isaksson; Gehrig Paola A; Pierce Stuart; Havrilesky Laura; Secord Angeles Alvarez; Dottino Joseph; Fader Amanda N; Ricci Stephanie; Geller Melissa A^*

来源：Gynecologic Oncology, 2015, 139(2): 275-282.

DOI：10.1016/j.ygyno.2015.09.002

• Uterine carcinosarcoma
• Multimodal therapy
• Survival
• MMMT
• Chemotherapy
• Radiation

Objective. To evaluate the use of adjuvant therapy after primary surgery for stage I-Ill uterine carcinosarcoma (CS).
Methods. A multi-institutional retrospective study of women with stage I-Ill CS was conducted. Analyses were stratified by stage (I/II and III). Patients were categorized according to adjuvant therapy: observation (OBS), radiation (RT), chemotherapy (CT) or multimodal therapy (CT + RT). Overall survival (OS) and progression-free survival (PFS) were analyzed using log-rank tests and Cox proportional hazards models.
Results. 303 patients were identified across four institutions: 195 with stage I/II and 108 with stage III disease. In stage I/II disease, 75 (39.9%) received OBS, 33 (17.6%) CT, 37 (19.7%) RT, and 43 (22.9%) CT + RT. OBS was associated with a fourfold increased risk of death compared to CT (adjusted hazard ratio (aHR) = 4.48, p = 0.003). Patients receiving CT + RT had significantly improved PFS compared to those receiving CT alone (aHR = 0.43, p = 0.04), but no difference in OS. In the stage III cohort, 16 (15.0%) received OBS, 34 (31.8%) CT, 20 (18.7%) RT, and 37 (34.6%) CT + RT. OBS was associated with worse OS and PFS compared to CT (OS: aHR = 2.46, p = 0.04; PFS: aHR = 2.39, p = 0.03, respectively). A potential improvement in PFS was seen for those treated with CT + RT compared to CT alone, however it was not statistically significant (aHR = 0.53, p = 0.09).
Conclusions. Observation after surgery was associated with poor outcomes in uterine CS compared to CT and RT alone. Multimodality therapy for women with stage I/II disease was associated with improved PFS compared to chemotherapy alone. Novel treatment options are needed to improve outcomes in this aggressive disease.

• 出版日期2015-11