Proposal for a Risk-Based Categorization of 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 journalArticle

3 Scopus citations

Abstract

Purpose: To propose a categorization model of uterine carcinosarcoma (UCS) based on tumor cell types (carcinoma and sarcoma) and sarcoma dominance. Methods: This secondary analysis of a prior multicenter retrospective study examined 889 cases of UCS with available histologic evaluation. Based on survival outcome, cases were clustered into three groups: low-grade carcinoma with nondominant homologous sarcoma [type A, n = 96 (10.8%)], (1) low-grade carcinoma with heterologous sarcoma or any sarcoma dominance and (2) high-grade carcinoma with nondominant homologous sarcoma [type B, n = 412 (46.3%)], and high-grade carcinoma with heterologous sarcoma or any sarcoma dominance [type C, n = 381 (42.9%)]. Tumor characteristics and outcome were examined based on the categorization. Results: Women in type C category were more likely to be older, obese, and Caucasian, whereas those in type A category were younger, less obese, Asian, and nulligravid (all P < 0.01). Type C tumors were more likely to have metastatic implants, large tumor size, lymphovascular space invasion with sarcoma cells, and higher lymph node ratio, whereas type A tumors were more likely to be early-stage disease and small (all P < 0.05). On multivariate analysis, tumor categorization was independently associated with progression-free survival (5-year rates: 70.1% for type A, 48.3% for type B, and 35.9% for type C, adjusted P < 0.01) and cause-specific survival (5-year rates: 82.8% for type A, 63.0% for type B, and 47.1% for type C, adjusted P < 0.01). Conclusion: Characteristic differences in clinicopathological factors and outcomes in UCS imply that different underlying etiologies and biological behaviors may be present, supporting a new classification system.

Original languageEnglish (US)
Pages (from-to)3676-3684
Number of pages9
JournalAnnals of Surgical Oncology
Volume25
Issue number12
DOIs
StatePublished - Nov 1 2018

ASJC Scopus subject areas

  • Surgery
  • Oncology

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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). Proposal for a Risk-Based Categorization of Uterine Carcinosarcoma. Annals of Surgical Oncology, 25(12), 3676-3684. https://doi.org/10.1245/s10434-018-6695-z