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

Elizabeth L. Dickson, Rachel Isaksson Vogel, Paola A. Gehrig, Stuart Pierce, Laura Havrilesky, Angeles Alvarez Secord, Joseph Dottino, Amanda N. Fader, Stephanie Ricci, Melissa A. Geller

Research output: Contribution to journalArticle

Abstract

Objective To evaluate the use of adjuvant therapy after primary surgery for stage I-III uterine carcinosarcoma (CS). Methods A multi-institutional retrospective study of women with stage I-III 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.

Original languageEnglish (US)
Pages (from-to)275-282
Number of pages8
JournalGynecologic oncology
Volume139
Issue number2
DOIs
StatePublished - 2015

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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  • Cite this

    Dickson, E. L., Vogel, R. I., Gehrig, P. A., Pierce, S., Havrilesky, L., Secord, A. A., Dottino, J., Fader, A. N., Ricci, S., & Geller, M. A. (2015). A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma. Gynecologic oncology, 139(2), 275-282. https://doi.org/10.1016/j.ygyno.2015.09.002