TY - JOUR
T1 - Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma
AU - Matsuo, K.
AU - Takazawa, Y.
AU - Ross, M. S.
AU - Elishaev, E.
AU - Podzielinski, I.
AU - Yunokawa, M.
AU - Sheridan, T. B.
AU - Bush, S. H.
AU - Klobocista, M. M.
AU - Blake, E. A.
AU - Takano, T.
AU - Matsuzaki, S.
AU - Baba, T.
AU - Satoh, S.
AU - Shida, M.
AU - Nishikawa, T.
AU - Ikeda, Y.
AU - Adachi, S.
AU - Yokoyama, T.
AU - Takekuma, M.
AU - Fujiwara, K.
AU - Hazama, Y.
AU - Kadogami, D.
AU - Moffitt, M. N.
AU - Takeuchi, S.
AU - Nishimura, M.
AU - Iwasaki, K.
AU - Ushioda, N.
AU - Johnson, M. S.
AU - Yoshida, M.
AU - Hakam, A.
AU - Li, S. W.
AU - Richmond, A. M.
AU - Machida, H.
AU - Mhawech-Fauceglia, P.
AU - Ueda, Y.
AU - Yoshino, K.
AU - Yamaguchi, K.
AU - Oishi, T.
AU - Kajiwara, H.
AU - Hasegawa, K.
AU - Yasuda, M.
AU - Kawana, K.
AU - Suda, K.
AU - Miyake, T. M.
AU - Moriya, T.
AU - Yuba, Y.
AU - Morgan, T.
AU - Fukagawa, T.
AU - Wakatsuki, A.
AU - Sugiyama, T.
AU - Pejovic, T.
AU - Nagano, T.
AU - Shimoya, K.
AU - Andoh, M.
AU - Shiki, Y.
AU - Enomoto, T.
AU - Sasaki, T.
AU - Fujiwara, K.
AU - Mikami, M.
AU - Shimada, M.
AU - Konishi, I.
AU - Kimura, T.
AU - Post, M. D.
AU - Shahzad, M. M.
AU - Im, D. D.
AU - Yoshida, H.
AU - Omatsu, K.
AU - Ueland, F. R.
AU - Kelley, J. L.
AU - Karabakhtsian, R. G.
AU - Roman, L. D.
N1 - Publisher Copyright:
© The Author 2016.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
KW - Carcinoma
KW - Chemotherapy
KW - Histology
KW - Sarcoma
KW - Survival outcome
KW - Uterine carcinosarcoma
UR - http://www.scopus.com/inward/record.url?scp=84977083839&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84977083839&partnerID=8YFLogxK
U2 - 10.1093/annonc/mdw161
DO - 10.1093/annonc/mdw161
M3 - Article
C2 - 27052653
AN - SCOPUS:84977083839
SN - 0923-7534
VL - 27
SP - 1257
EP - 1266
JO - Annals of Oncology
JF - Annals of Oncology
IS - 7
ER -