Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years

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

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years.

METHODS: This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I-IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 (n = 82 [9.1%]), aged 60-79, (n = 526 [58.1%]), and aged <60 (n = 298 [32.9%]).

RESULTS: Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group (P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60-79 group (HR 0.97, 95%CI 0.51-1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60-79 group (HR 1.62, 95%CI 1.09-2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy.

CONCLUSION: Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group.

Original languageEnglish
Pages (from-to)25-32
Number of pages8
JournalSurgical Oncology
Volume29
DOIs
Publication statusPublished - Jun 2019
Externally publishedYes

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