Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma

K. Matsuo, Y. Takazawa, M. S. Ross, E. Elishaev, I. Podzielinski, M. Yunokawa, T. B. Sheridan, S. H. Bush, M. M. Klobocista, E. A. Blake, T. Takano, S. Matsuzaki, T. Baba, S. Satoh, M. Shida, T. Nishikawa, Y. Ikeda, S. Adachi, T. Yokoyama, M. TakekumaK. Fujiwara, Y. Hazama, D. Kadogami, M. N. Moffitt, S. Takeuchi, M. Nishimura, K. Iwasaki, N. Ushioda, M. S. Johnson, M. Yoshida, A. Hakam, S. W. Li, A. M. Richmond, H. Machida, P. Mhawech-Fauceglia, Y. Ueda, K. Yoshino, K. Yamaguchi, T. Oishi, H. Kajiwara, K. Hasegawa, M. Yasuda, K. Kawana, K. Suda, T. M. Miyake, T. Moriya, Y. Yuba, T. Morgan, T. Fukagawa, A. Wakatsuki, T. Sugiyama, T. Pejovic, T. Nagano, K. Shimoya, M. Andoh, Y. Shiki, T. Enomoto, T. Sasaki, K. Fujiwara, M. Mikami, M. Shimada, I. Konishi, T. Kimura, M. D. Post, M. M. Shahzad, D. D. Im, H. Yoshida, K. Omatsu, F. R. Ueland, J. L. Kelley, R. G. Karabakhtsian, L. D. Roman

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Abstract

Background: To examine the effect of the histology of carcinoma and sarcoma components on survival outcome ofuterine carcinosarcoma.Patients and methods: A multicenter retrospective study was conducted to examine uterine carcinosarcoma casesthat underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating toclinico-pathological demographics and outcomes.Results: Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma)with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%),low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous(5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%,P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrialinvasion, lymphovascular space invasion, and advanced-stage disease were independently associated withdecreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) andradiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis.However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improvedPFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatmentbenefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum forhigh-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017),and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, andanthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared withnon-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracyclinefor high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improvedPFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, whilesarcoma components tended to spreadloco-regionally (P < 0.001).Conclusion: Characterization of histologic pattern provides valuable information in the management of uterinecarcinosarcoma.

Original languageEnglish (US)
Pages (from-to)1257-1266
Number of pages10
JournalAnnals of Oncology
Volume27
Issue number7
DOIs
StatePublished - Jul 1 2016

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Keywords

  • Carcinoma
  • Chemotherapy
  • Histology
  • Sarcoma
  • Survival outcome
  • Uterine carcinosarcoma

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Matsuo, K., Takazawa, Y., Ross, M. S., Elishaev, E., Podzielinski, I., Yunokawa, M., Sheridan, T. B., Bush, S. H., Klobocista, M. M., Blake, E. A., Takano, T., Matsuzaki, S., Baba, T., Satoh, S., Shida, M., Nishikawa, T., Ikeda, Y., Adachi, S., Yokoyama, T., ... Roman, L. D. (2016). Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Annals of Oncology, 27(7), 1257-1266. https://doi.org/10.1093/annonc/mdw161