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

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21 Citations (Scopus)

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 languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusE-pub ahead of print - Feb 16 2017

Keywords

  • Journal Article

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