The impact of multi-modal therapy on survival for uterine carcinosarcomas

Jesus Gonzalez Bosquet, Shelby A. Terstriep, William Arthur Cliby, Monica Brown-Jones, Judith S Kaur, Karl C. Podratz, Gary Keeney

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objectives: To investigate treatment outcomes of patients with carcinosarcoma of the uterus and to identify parameters predictive of survival. Secondary objectives included (a) the assessment of treatment failures as a function of histologic subtypes and (b) the impact of the new FIGO staging classification system. Methods: This is a retrospective outcomes analysis of 121 patients diagnosed with primary carcinosarcoma of the uterus. Clinical, surgical and pathological data were reviewed and patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma. Survivorship curves were evaluated with the log-rank test and associations between events and variables with Cox proportional hazards model. Results: In the multivariate analyses for disease-specific survival (DSS) and disease-free survival (DFS), the only independent factors were FIGO stage, adjuvant chemotherapy after surgery and the presence of clear cell histology in the tumor. The 5-year DSS for stages I-II, III and IV was 59%, 22% and 9%, respectively. The administration of platin-based chemotherapy provided a significant benefit with regard to both DFS (OR = 0.28; p = 0.001) and DSS (OR = 0.35; p = 0.01). While radiotherapy (RT) appeared to control vaginal failures in all stages, pelvic RT did not impact DSS. Of importance, the epithelial component was the predominant histology in both the primary extrauterine metastases (94%) and the distant failure sites (82%). Conclusions: This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systemic therapy in patients with both early and advanced stage disease.

Original languageEnglish (US)
Pages (from-to)419-423
Number of pages5
JournalGynecologic Oncology
Volume116
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Carcinosarcoma
Survival
Disease-Free Survival
Uterus
Histology
Radiotherapy
Therapeutics
Neoplasms
Adjuvant Chemotherapy
Endometrial Neoplasms
Treatment Failure
Proportional Hazards Models
Multivariate Analysis
Survival Rate
Neoplasm Metastasis
Drug Therapy

Keywords

  • Carcinosarcomas
  • FIGO staging
  • Treatment outcomes

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

The impact of multi-modal therapy on survival for uterine carcinosarcomas. / Gonzalez Bosquet, Jesus; Terstriep, Shelby A.; Cliby, William Arthur; Brown-Jones, Monica; Kaur, Judith S; Podratz, Karl C.; Keeney, Gary.

In: Gynecologic Oncology, Vol. 116, No. 3, 03.2010, p. 419-423.

Research output: Contribution to journalArticle

Gonzalez Bosquet, Jesus ; Terstriep, Shelby A. ; Cliby, William Arthur ; Brown-Jones, Monica ; Kaur, Judith S ; Podratz, Karl C. ; Keeney, Gary. / The impact of multi-modal therapy on survival for uterine carcinosarcomas. In: Gynecologic Oncology. 2010 ; Vol. 116, No. 3. pp. 419-423.
@article{9a7e93e5e7f8458f93127489a4a2619c,
title = "The impact of multi-modal therapy on survival for uterine carcinosarcomas",
abstract = "Objectives: To investigate treatment outcomes of patients with carcinosarcoma of the uterus and to identify parameters predictive of survival. Secondary objectives included (a) the assessment of treatment failures as a function of histologic subtypes and (b) the impact of the new FIGO staging classification system. Methods: This is a retrospective outcomes analysis of 121 patients diagnosed with primary carcinosarcoma of the uterus. Clinical, surgical and pathological data were reviewed and patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma. Survivorship curves were evaluated with the log-rank test and associations between events and variables with Cox proportional hazards model. Results: In the multivariate analyses for disease-specific survival (DSS) and disease-free survival (DFS), the only independent factors were FIGO stage, adjuvant chemotherapy after surgery and the presence of clear cell histology in the tumor. The 5-year DSS for stages I-II, III and IV was 59{\%}, 22{\%} and 9{\%}, respectively. The administration of platin-based chemotherapy provided a significant benefit with regard to both DFS (OR = 0.28; p = 0.001) and DSS (OR = 0.35; p = 0.01). While radiotherapy (RT) appeared to control vaginal failures in all stages, pelvic RT did not impact DSS. Of importance, the epithelial component was the predominant histology in both the primary extrauterine metastases (94{\%}) and the distant failure sites (82{\%}). Conclusions: This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systemic therapy in patients with both early and advanced stage disease.",
keywords = "Carcinosarcomas, FIGO staging, Treatment outcomes",
author = "{Gonzalez Bosquet}, Jesus and Terstriep, {Shelby A.} and Cliby, {William Arthur} and Monica Brown-Jones and Kaur, {Judith S} and Podratz, {Karl C.} and Gary Keeney",
year = "2010",
month = "3",
doi = "10.1016/j.ygyno.2009.10.053",
language = "English (US)",
volume = "116",
pages = "419--423",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - The impact of multi-modal therapy on survival for uterine carcinosarcomas

AU - Gonzalez Bosquet, Jesus

AU - Terstriep, Shelby A.

AU - Cliby, William Arthur

AU - Brown-Jones, Monica

AU - Kaur, Judith S

AU - Podratz, Karl C.

AU - Keeney, Gary

PY - 2010/3

Y1 - 2010/3

N2 - Objectives: To investigate treatment outcomes of patients with carcinosarcoma of the uterus and to identify parameters predictive of survival. Secondary objectives included (a) the assessment of treatment failures as a function of histologic subtypes and (b) the impact of the new FIGO staging classification system. Methods: This is a retrospective outcomes analysis of 121 patients diagnosed with primary carcinosarcoma of the uterus. Clinical, surgical and pathological data were reviewed and patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma. Survivorship curves were evaluated with the log-rank test and associations between events and variables with Cox proportional hazards model. Results: In the multivariate analyses for disease-specific survival (DSS) and disease-free survival (DFS), the only independent factors were FIGO stage, adjuvant chemotherapy after surgery and the presence of clear cell histology in the tumor. The 5-year DSS for stages I-II, III and IV was 59%, 22% and 9%, respectively. The administration of platin-based chemotherapy provided a significant benefit with regard to both DFS (OR = 0.28; p = 0.001) and DSS (OR = 0.35; p = 0.01). While radiotherapy (RT) appeared to control vaginal failures in all stages, pelvic RT did not impact DSS. Of importance, the epithelial component was the predominant histology in both the primary extrauterine metastases (94%) and the distant failure sites (82%). Conclusions: This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systemic therapy in patients with both early and advanced stage disease.

AB - Objectives: To investigate treatment outcomes of patients with carcinosarcoma of the uterus and to identify parameters predictive of survival. Secondary objectives included (a) the assessment of treatment failures as a function of histologic subtypes and (b) the impact of the new FIGO staging classification system. Methods: This is a retrospective outcomes analysis of 121 patients diagnosed with primary carcinosarcoma of the uterus. Clinical, surgical and pathological data were reviewed and patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma. Survivorship curves were evaluated with the log-rank test and associations between events and variables with Cox proportional hazards model. Results: In the multivariate analyses for disease-specific survival (DSS) and disease-free survival (DFS), the only independent factors were FIGO stage, adjuvant chemotherapy after surgery and the presence of clear cell histology in the tumor. The 5-year DSS for stages I-II, III and IV was 59%, 22% and 9%, respectively. The administration of platin-based chemotherapy provided a significant benefit with regard to both DFS (OR = 0.28; p = 0.001) and DSS (OR = 0.35; p = 0.01). While radiotherapy (RT) appeared to control vaginal failures in all stages, pelvic RT did not impact DSS. Of importance, the epithelial component was the predominant histology in both the primary extrauterine metastases (94%) and the distant failure sites (82%). Conclusions: This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systemic therapy in patients with both early and advanced stage disease.

KW - Carcinosarcomas

KW - FIGO staging

KW - Treatment outcomes

UR - http://www.scopus.com/inward/record.url?scp=75749084357&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=75749084357&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2009.10.053

DO - 10.1016/j.ygyno.2009.10.053

M3 - Article

C2 - 19896181

AN - SCOPUS:75749084357

VL - 116

SP - 419

EP - 423

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 3

ER -