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

Koji Matsuo; Kohei Omatsu; Malcolm S Ross; Marian S Johnson; Mayu Yunokawa; Merieme M Klobocista; Dwight D Im; Stephen H Bush; Yutaka Ueda; Tadao Takano; Erin A Blake; Kosei Hasegawa; Tsukasa Baba; Masako Shida; Shinya Satoh; Takuhei Yokoyama; Hiroko Machida; Sosuke Adachi; Yuji Ikeda; Keita Iwasaki; Takahito M Miyake; Shiori Yanai; Masato Nishimura; Tadayoshi Nagano; Munetaka Takekuma; Satoshi Takeuchi; Tanja Pejovic; Mian Mk Shahzad; Frederick R Ueland; Joseph L Kelley; Lynda D Roman

doi:10.1016/j.ygyno.2017.02.001

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

Koji Matsuo, Kohei Omatsu, Malcolm S Ross, Marian S Johnson, Mayu Yunokawa, Merieme M Klobocista, Dwight D Im, Stephen H Bush, Yutaka Ueda, Tadao Takano, Erin A Blake, Kosei Hasegawa, Tsukasa Baba, Masako Shida, Shinya Satoh, Takuhei Yokoyama, Hiroko Machida, Sosuke Adachi, Yuji Ikeda, Keita IwasakiTakahito M Miyake, Shiori Yanai, Masato Nishimura, Tadayoshi Nagano, Munetaka Takekuma, Satoshi Takeuchi, Tanja Pejovic, Mian Mk Shahzad, Frederick R Ueland, Joseph L Kelley, Lynda D Roman

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Journal	Gynecologic Oncology
DOIs	https://doi.org/10.1016/j.ygyno.2017.02.001
Publication status	E-pub ahead of print - Feb 16 2017

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Journal Article

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10.1016/j.ygyno.2017.02.001

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Matsuo, K., Omatsu, K., Ross, M. S., Johnson, M. S., Yunokawa, M., Klobocista, M. M., Im, D. D., Bush, S. H., Ueda, Y., Takano, T., Blake, E. A., Hasegawa, K., Baba, T., Shida, M., Satoh, S., Yokoyama, T., Machida, H., Adachi, S., Ikeda, Y., ... Roman, L. D. (2017). Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2017.02.001

Matsuo, K, Omatsu, K, Ross, MS, Johnson, MS, Yunokawa, M, Klobocista, MM, Im, DD, Bush, SH, Ueda, Y, Takano, T, Blake, EA, Hasegawa, K, Baba, T, Shida, M, Satoh, S, Yokoyama, T, Machida, H, Adachi, S, Ikeda, Y, Iwasaki, K, Miyake, TM, Yanai, S, Nishimura, M, Nagano, T, Takekuma, M, Takeuchi, S, Pejovic, T, Shahzad, MM, Ueland, FR, Kelley, JL & Roman, LD 2017, 'Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma', Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2017.02.001

@article{c7174190eed444eebb0a664e5b143dd4,

title = "Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma",

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 = "Journal Article",

author = "Koji Matsuo and Kohei Omatsu and Ross, {Malcolm S} and Johnson, {Marian S} and Mayu Yunokawa and Klobocista, {Merieme M} and Im, {Dwight D} and Bush, {Stephen H} and Yutaka Ueda and Tadao Takano and Blake, {Erin A} and Kosei Hasegawa and Tsukasa Baba and Masako Shida and Shinya Satoh and Takuhei Yokoyama and Hiroko Machida and Sosuke Adachi and Yuji Ikeda and Keita Iwasaki and Miyake, {Takahito M} and Shiori Yanai and Masato Nishimura and Tadayoshi Nagano and Munetaka Takekuma and Satoshi Takeuchi and Tanja Pejovic and Shahzad, {Mian Mk} and Ueland, {Frederick R} and Kelley, {Joseph L} and Roman, {Lynda D}",

year = "2017",

month = feb,

day = "16",

doi = "10.1016/j.ygyno.2017.02.001",

language = "English",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma

AU - Matsuo, Koji

AU - Omatsu, Kohei

AU - Ross, Malcolm S

AU - Johnson, Marian S

AU - Yunokawa, Mayu

AU - Klobocista, Merieme M

AU - Im, Dwight D

AU - Bush, Stephen H

AU - Ueda, Yutaka

AU - Takano, Tadao

AU - Blake, Erin A

AU - Hasegawa, Kosei

AU - Baba, Tsukasa

AU - Shida, Masako

AU - Satoh, Shinya

AU - Yokoyama, Takuhei

AU - Machida, Hiroko

AU - Adachi, Sosuke

AU - Ikeda, Yuji

AU - Iwasaki, Keita

AU - Miyake, Takahito M

AU - Yanai, Shiori

AU - Nishimura, Masato

AU - Nagano, Tadayoshi

AU - Takekuma, Munetaka

AU - Takeuchi, Satoshi

AU - Pejovic, Tanja

AU - Shahzad, Mian Mk

AU - Ueland, Frederick R

AU - Kelley, Joseph L

AU - Roman, Lynda D

PY - 2017/2/16

Y1 - 2017/2/16

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.ygyno.2017.02.001

DO - 10.1016/j.ygyno.2017.02.001

M3 - Article

C2 - 28215838

SN - 0090-8258

JO - Gynecologic Oncology

JF - Gynecologic Oncology

ER -

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

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