Uterine carcinosarcoma: A 10-Year single institution experience
Thesis (MPhil)--Stellenbosch University, 2019.
Objective: This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic features, to recognize patterns of recurrence and to identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS). Materials and Methods: A total of 61 patients with uterine carcinosarcoma who were diagnosed between January 2005 and December 2014 were included. Demographic, clinicopathological, treatment and outcome information were obtained. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the effects of variables on PFS and OS. Results: Eighteen patients (29%) presented as FIGO stage I disease, 5 patients (8%) as stage II, 16 patients (26%) as stage III and 22 patients (36%) as stage IV disease, of which 50 patients (82%) had surgery. Seventeen patients presented with recurrence of which 5 (29.4%) were local and 12 (70.6%) were outside the pelvis. Five-year PFS and 5-year OS were 17.3% (CI 8.9%-27.9%) and 19.7% (CI 10.6%-30.8%), respectively. In the univariate analysis, tumour diameter ≥ 100mm (HR 4.57, p-value 0.005) was associated with 5-year PFS and in univariate analysis of OS, a positive family history (HR 0.42, p-value 0.047), receiving a full staging operation (HR 0.37, p-value 0.008) and receiving any other modality of treatment, with or without surgery, (HR 0.48, p-value 0.012) was associated with better survival. An abnormal pap smear (HR 2.4, p-value 0.041), late-stage disease (HR 3.48, p-value < 0.001), presence of residual tumour (HR 3.66, p-value < 0.001), myometrial invasion more than 50% (HR 2.29, p-value 0.019), cervical involvement (HR 3.38, p-value 0.001) and adnexal involvement (HR 3.21, p-value 0.002) were associated with a higher risk of death. In the multivariate analysis, full staging operation was associated with a risk of progression of disease (HR 3.49, p-value 0.025). Advanced stage (HR 4.2, p-value < 0.001) was associated with a higher risk of death. Any other modality of treatment (HR 0.28, p-value < 0.001) and full staging laparotomy (HR 0.27, p-value 0.001) was a protective factor for death. Conclusions: Carcinosarcoma is an aggressive cancer with poorer survival than previously described. Biological or genetic factors may play a role in our study population. Most recurrences occur outside of the pelvis. Full staging surgery (including pelvic lymphadenectomy) and additional use of other modalities (either for radical or palliative intent) improve survival.
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