Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma

Koji Matsuo; Yutaka Takazawa; Malcolm S Ross; Esther Elishaev; Mayu Yunokawa; Todd B Sheridan; Stephen H Bush; Merieme M Klobocista; Erin A Blake; Tadao Takano; Tsukasa Baba; Shinya Satoh; Masako Shida; Yuji Ikeda; Sosuke Adachi; Takuhei Yokoyama; Munetaka Takekuma; Shiori Yanai; Satoshi Takeuchi; Masato Nishimura; Keita Iwasaki; Marian S Johnson; Masayuki Yoshida; Ardeshir Hakam; Hiroko Machida; Paulette Mhawech-Fauceglia; Yutaka Ueda; Kiyoshi Yoshino; Hiroshi Kajiwara; Kosei Hasegawa; Masanori Yasuda; Takahito M Miyake; Takuya Moriya; Yoshiaki Yuba; Terry Morgan; Tomoyuki Fukagawa; Tanja Pejovic; Tadayoshi Nagano; Takeshi Sasaki; Abby M Richmond; Miriam D Post; Mian M K Shahzad; Dwight D Im; Hiroshi Yoshida; Takayuki Enomoto; Kohei Omatsu; Frederick R Ueland; Joseph L Kelley; Rouzan G Karabakhtsian; Lynda D Roman

doi:10.1245/s10434-018-6547-x

Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma

Koji Matsuo, Yutaka Takazawa, Malcolm S Ross, Esther Elishaev, Mayu Yunokawa, Todd B Sheridan, Stephen H Bush, Merieme M Klobocista, Erin A Blake, Tadao Takano, Tsukasa Baba, Shinya Satoh, Masako Shida, Yuji Ikeda, Sosuke Adachi, Takuhei Yokoyama, Munetaka Takekuma, Shiori Yanai, Satoshi Takeuchi, Masato NishimuraKeita Iwasaki, Marian S Johnson, Masayuki Yoshida, Ardeshir Hakam, Hiroko Machida, Paulette Mhawech-Fauceglia, Yutaka Ueda, Kiyoshi Yoshino, Hiroshi Kajiwara, Kosei Hasegawa, Masanori Yasuda, Takahito M Miyake, Takuya Moriya, Yoshiaki Yuba, Terry Morgan, Tomoyuki Fukagawa, Tanja Pejovic, Tadayoshi Nagano, Takeshi Sasaki, Abby M Richmond, Miriam D Post, Mian M K Shahzad, Dwight D Im, Hiroshi Yoshida, Takayuki Enomoto, Kohei Omatsu, Frederick R Ueland, Joseph L Kelley, Rouzan G Karabakhtsian, Lynda D Roman

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

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Abstract

OBJECTIVE: The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS).

METHODS: This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome.

RESULTS: Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08).

CONCLUSION: In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.

Original language	English
Pages (from-to)	2756-2766
Number of pages	11
Journal	Annals of Surgical Oncology
Volume	25
Issue number	9
DOIs	https://doi.org/10.1245/s10434-018-6547-x
Publication status	Published - Sept 2018
Externally published	Yes

Keywords

Blood Vessels/pathology
Carcinosarcoma/pathology
Chemotherapy, Adjuvant
Disease Progression
Female
Humans
Hysterectomy
Lymphatic Metastasis
Lymphatic Vessels/pathology
Middle Aged
Neoplasm Invasiveness
Progression-Free Survival
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate
Uterine Neoplasms/pathology

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10.1245/s10434-018-6547-x

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Matsuo, K., Takazawa, Y., Ross, M. S., Elishaev, E., Yunokawa, M., Sheridan, T. B., Bush, S. H., Klobocista, M. M., Blake, E. A., Takano, T., Baba, T., Satoh, S., Shida, M., Ikeda, Y., Adachi, S., Yokoyama, T., Takekuma, M., Yanai, S., Takeuchi, S., ... Roman, L. D. (2018). Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma. Annals of Surgical Oncology, 25(9), 2756-2766. https://doi.org/10.1245/s10434-018-6547-x

Matsuo, K, Takazawa, Y, Ross, MS, Elishaev, E, Yunokawa, M, Sheridan, TB, Bush, SH, Klobocista, MM, Blake, EA, Takano, T, Baba, T, Satoh, S, Shida, M, Ikeda, Y, Adachi, S, Yokoyama, T, Takekuma, M, Yanai, S, Takeuchi, S, Nishimura, M, Iwasaki, K, Johnson, MS, Yoshida, M, Hakam, A, Machida, H, Mhawech-Fauceglia, P, Ueda, Y, Yoshino, K, Kajiwara, H, Hasegawa, K, Yasuda, M, Miyake, TM, Moriya, T, Yuba, Y, Morgan, T, Fukagawa, T, Pejovic, T, Nagano, T, Sasaki, T, Richmond, AM, Post, MD, Shahzad, MMK, Im, DD, Yoshida, H, Enomoto, T, Omatsu, K, Ueland, FR, Kelley, JL, Karabakhtsian, RG & Roman, LD 2018, 'Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma', Annals of Surgical Oncology, vol. 25, no. 9, pp. 2756-2766. https://doi.org/10.1245/s10434-018-6547-x

@article{1b71a2fb2acd454786b67ae5a2c1f4c1,

title = "Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma",

abstract = "OBJECTIVE: The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS).METHODS: This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome.RESULTS: Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08).CONCLUSION: In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.",

keywords = "Blood Vessels/pathology, Carcinosarcoma/pathology, Chemotherapy, Adjuvant, Disease Progression, Female, Humans, Hysterectomy, Lymphatic Metastasis, Lymphatic Vessels/pathology, Middle Aged, Neoplasm Invasiveness, Progression-Free Survival, Radiotherapy, Adjuvant, Retrospective Studies, Survival Rate, Uterine Neoplasms/pathology",

author = "Koji Matsuo and Yutaka Takazawa and Ross, {Malcolm S} and Esther Elishaev and Mayu Yunokawa and Sheridan, {Todd B} and Bush, {Stephen H} and Klobocista, {Merieme M} and Blake, {Erin A} and Tadao Takano and Tsukasa Baba and Shinya Satoh and Masako Shida and Yuji Ikeda and Sosuke Adachi and Takuhei Yokoyama and Munetaka Takekuma and Shiori Yanai and Satoshi Takeuchi and Masato Nishimura and Keita Iwasaki and Johnson, {Marian S} and Masayuki Yoshida and Ardeshir Hakam and Hiroko Machida and Paulette Mhawech-Fauceglia and Yutaka Ueda and Kiyoshi Yoshino and Hiroshi Kajiwara and Kosei Hasegawa and Masanori Yasuda and Miyake, {Takahito M} and Takuya Moriya and Yoshiaki Yuba and Terry Morgan and Tomoyuki Fukagawa and Tanja Pejovic and Tadayoshi Nagano and Takeshi Sasaki and Richmond, {Abby M} and Post, {Miriam D} and Shahzad, {Mian M K} and Im, {Dwight D} and Hiroshi Yoshida and Takayuki Enomoto and Kohei Omatsu and Ueland, {Frederick R} and Kelley, {Joseph L} and Karabakhtsian, {Rouzan G} and Roman, {Lynda D}",

year = "2018",

month = sep,

doi = "10.1245/s10434-018-6547-x",

language = "English",

volume = "25",

pages = "2756--2766",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "9",

}

TY - JOUR

T1 - Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma

AU - Matsuo, Koji

AU - Takazawa, Yutaka

AU - Ross, Malcolm S

AU - Elishaev, Esther

AU - Yunokawa, Mayu

AU - Sheridan, Todd B

AU - Bush, Stephen H

AU - Klobocista, Merieme M

AU - Blake, Erin A

AU - Takano, Tadao

AU - Baba, Tsukasa

AU - Satoh, Shinya

AU - Shida, Masako

AU - Ikeda, Yuji

AU - Adachi, Sosuke

AU - Yokoyama, Takuhei

AU - Takekuma, Munetaka

AU - Yanai, Shiori

AU - Takeuchi, Satoshi

AU - Nishimura, Masato

AU - Iwasaki, Keita

AU - Johnson, Marian S

AU - Yoshida, Masayuki

AU - Hakam, Ardeshir

AU - Machida, Hiroko

AU - Mhawech-Fauceglia, Paulette

AU - Ueda, Yutaka

AU - Yoshino, Kiyoshi

AU - Kajiwara, Hiroshi

AU - Hasegawa, Kosei

AU - Yasuda, Masanori

AU - Miyake, Takahito M

AU - Moriya, Takuya

AU - Yuba, Yoshiaki

AU - Morgan, Terry

AU - Fukagawa, Tomoyuki

AU - Pejovic, Tanja

AU - Nagano, Tadayoshi

AU - Sasaki, Takeshi

AU - Richmond, Abby M

AU - Post, Miriam D

AU - Shahzad, Mian M K

AU - Im, Dwight D

AU - Yoshida, Hiroshi

AU - Enomoto, Takayuki

AU - Omatsu, Kohei

AU - Ueland, Frederick R

AU - Kelley, Joseph L

AU - Karabakhtsian, Rouzan G

AU - Roman, Lynda D

PY - 2018/9

Y1 - 2018/9

N2 - OBJECTIVE: The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS).METHODS: This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome.RESULTS: Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08).CONCLUSION: In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.

AB - OBJECTIVE: The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS).METHODS: This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome.RESULTS: Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08).CONCLUSION: In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.

KW - Blood Vessels/pathology

KW - Carcinosarcoma/pathology

KW - Chemotherapy, Adjuvant

KW - Disease Progression

KW - Female

KW - Humans

KW - Hysterectomy

KW - Lymphatic Metastasis

KW - Lymphatic Vessels/pathology

KW - Middle Aged

KW - Neoplasm Invasiveness

KW - Progression-Free Survival

KW - Radiotherapy, Adjuvant

KW - Retrospective Studies

KW - Survival Rate

KW - Uterine Neoplasms/pathology

U2 - 10.1245/s10434-018-6547-x

DO - 10.1245/s10434-018-6547-x

M3 - Article

C2 - 29971677

SN - 1068-9265

VL - 25

SP - 2756

EP - 2766

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 9

ER -

Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma

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