Menopausal Status at Diagnosis is a Prognostic Indicator in Patients who are Operated for Uterine Carcinosarcoma

Abstract

Objectives: Uterine carcinosarcoma is a rare type of uterine cancer, and due to its rarity, there is limited evidence for prognostic factors and treatment. The objective of this study is to assess the influence of histologic, clinical, and demographic characteristics on overall survival (OS) and recurrence-free survival (RFS). Materials and Methods: Patients who had diagnosis of uterine carcinosarcoma and followed by the medical oncology department of three hospitals from Türkiye between January 2013 and January 2023 were retrospectively evaluated. All patients had local disease and were surgically managed, and patients were excluded if they did not have primary surgical management. Results: The study included 62 women who were primarily treated with surgery and had a median age of 64.5 (interquartile range=14) years. Recurrence was observed in 26 patients (41.9%), with a median RFS of 11.63 months [95% confidence interval (CI): 1.99-21.26]. A shorter RFS was observed in patients with myometrial invasion [hazard ratio (HR) 2.48, 95% CI 1.04-5.93, p=0.04], while postmenopausal diagnosis was a predictor for longer RFS (HR 0.02, 95% CI 0.004-0.14, p<0.001). The median OS was 43.17 months. Postmenopausal diagnosis was associated with prolonged OS (HR 0.003, 95% CI 0-0.45, p<0.001). Conclusion: The results of our study show that being diagnosed before menopause is linked to a shorter RFS and OS in women with uterine carcinosarcoma who had surgery to treat local disease

Keywords

• Uterine carcinosarcoma
• prognostic factor
• menopausal status

Rezeksiyon Edilmiş Uterin Karsinosarkom Tanılı Hastalarda Prognostik Bir Gösterge Olarak Tanı Anındaki Menopozal Durum

Abstract

Amaç: Uterin karsinosarkom, nadir görülen bir uterus kanser türüdür ve nadir olması nedeniyle prognostik faktörler ve tedavi konusunda sınırlı veri bulunmaktadır. Bu çalışmanın amacı, histolojik, klinik ve demografik özelliklerin genel sağkalım (OS) ve nükssüz sağkalım (RFS) üzerindeki etkisini değerlendirmektir. Gereç ve Yöntem: Ocak 2013 ile Ocak 2023 tarihleri arasında Türkiye’deki üç hastanenin tıbbi onkoloji bölümünde takip edilen uterin karsinosarkom tanısı almış hastalar retrospektif olarak değerlendirildi. Tüm hastalar tanı anında lokal hastalığa sahipti ve cerrahi olarak tedavi edildi; tanı anında metastatik olan veya primer cerrahi yapılmayan hastalar çalışmaya dahil edilmedi. Bulgular: Çalışmaya, primer olarak cerrahi tedavi uygulanmış 62 kadın dahil edildi ve hastaların ortanca yaşı 64,5 (çeyrekler arası aralık=14) yıldı. Nüks, 26 hastada (%41,9) gözlendi ve ortanca RFS süresi 11,63 ay [%95 güven aralığı (GA): 1,99-21,26] olarak bulundu. Miyometrial invazyonu Address for Correspondence/Yazışma Adresi: Hatice Bölek, MD Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, Türkiye Sonuç: Bu çalışma lokal hastalık için cerrahi ile tedavi edilen karsinosarkom tanılı hastalarda premenopozal dönemde tanı almanın daha kısa RFS ve OS ile ilişkili olduğunu göstermiştir.

Keywords

• Uterin karsinosarkom
• prognostik faktör
• menapoz durumu

References

1. 1. Pezzicoli G, Moscaritolo F, Silvestris E, et al. Uterine carcinosarcoma: an overview. Critical Rev Oncol/Hematol. 2021;163:103369.
2. 2. El-Nashar SA, Mariani A. Uterine carcinosarcoma. Clin Obstet Gynecol. 2011;54:292-304.
3. 3. Leath CA 3rd Numnum TM, Kendrick JE 4th, et al. Patterns of failure for conservatively managed surgical stage I uterine carcinosarcoma: implications for adjuvant therapy. Int J Gynecol Cancer. 2009;19:888-891.
4. 4. Sartori E, Bazzurini L, Gadducci A, et al. Carcinosarcoma of the uterus: a clinicopathological multicenter CTF study. Gynecologic Oncology. 1997;67:70-75.
5. 5. Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in earlystage uterine sarcoma: a Gynecologic Oncology Group Study. Cancer. 1993;71:1702-1709.
6. 6. Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K. Uterine carcinosarcoma: contemporary clinical summary, molecular updates, and future research opportunity. Gynecol Oncol. 2021;160:586-601.
7. 7. Raffone A, Travaglino A, Raimondo D, et al. Uterine carcinosarcoma vs endometrial serous and clear cell carcinoma: a systematic review and metaanalysis of survival. Int J Gynecol Obstet. 2022;158:520-527.
8. 8. Toboni MD, Crane EK, Brown J, Shushkevich A, et al. Uterine carcinosarcomas: from pathology to practice. Gynecol Oncol. 2021;162:235-241.

9. 9. Gonzalez Bosquet J, Terstriep SA, Cliby WA, et al. The impact of multimodal therapy on survival for uterine carcinosarcomas. Gynecol Oncol. 2010;116:419-423.
10. 10. Bogani G, Ray-Coquard I, Concin N, et al. Endometrial carcinosarcoma. Int J Gynecol Cancer. 2023;33:147-174.
11. 11. Gotoh O, Sugiyama Y, Takazawa Y, et al. Clinically relevant molecular subtypes and genomic alteration-independent differentiation in gynecologic carcinosarcoma. Nature Communications. 2019;10:4965.
12. 12. Kurnit KC, Previs RA, Soliman PT, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol. 2019;152:31-37.
13. 13. Terblanche L, Botha MH. Uterine carcinosarcoma: a 10-year single institution experience. PloS One. 2022;17:0271526.
14. 14. Zhu J, Wen H, Bi R, Wu X. Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study. J Gynecol Oncol. 2016;27:18.
15. 15. Callister M, Ramondetta LM, Jhingran A, et al. Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Oncol Biol Phys. 2004;58:786-796.
16. 16. Nemani D, Mitra N, Guo M, et al. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol. 2008;111:82-88.
17. 17. NCCN Guidelines version 3.2025 Uterine Neoplasms [Internet]. [Retrieved on 2025] Available from: https://www.nccn.org/professionals/physician_ gls/pdf/uterine.pdf.
18. 18. Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol. 2016;26:2-30.
19. 19. Galaal K, van der Heijden E, Godfrey K, et al. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. Cochrane Database Syst Rev. 2013;2013:CD006812.
20. 20. Powell MA, Filiaci VL, Hensley ML, et al. Randomized phase III trial of paclitaxel and carboplatin versus paclitaxel and ifosfamide in patients with carcinosarcoma of the uterus or ovary: an NRG oncology trial. J Clin Oncol. 2022;40:968-977.
21. 21. Powell MA, Filiaci VL, Rose PG, et al. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol. 2010;28:2727-2731.
22. 22. Wu TI, Chang TC, Hsueh S, et al. Prognostic factors and impact of adjuvant chemotherapy for uterine leiomyosarcoma. Gynecol Oncol. 2006;100:166172.
23. 23. Abeler VM, Røyne O, Thoresen S, et al. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology. 2009;54:355-364.
24. 24. Chantharasamee J, Wong K, Potivongsajarn P, et al. Retrospective analysis of adjuvant treatment for localized, operable uterine leiomyosarcoma. Cancer Med. 2022;11:2906-2912.
25. 25. Harano K, Hirakawa A, Yunokawa M, et al. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Int J Clin Oncol. 2016;21:16876.
26. 26. Wolfson AH, Brady MF, Rocereto T, et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I–IV carcinosarcoma (CS) of the uterus. Gynecol oncol. 2007;107:177-185.
27. 27. Abdulfatah E, Lordello L, Khurram M, et al. Predictive histologic factors in carcinosarcomas of the uterus: a multi-institutional study. Int J Gynecol Pathol. 2019;38:205-215.
28. 28. Galaal K, Kew F, Tam K, et al. Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Gynecol Reprod Biol. 2009;143:88-92.
29. 29. Bodner-Adler B, Bodner K, Obermair A, et al. Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study. Anticancer Res. 2001;21:3069-3074.
30. 30. Ioffe Y, Li A, Walsh C, et al. Hormone receptor expression in uterine sarcomas: prognostic and therapeutic roles. Gynecol Oncology. 2009;115:466-71.
31. 31. Jones NL, Wu S, Xiu J, et al. Association of the presence of estrogen and progesterone receptors in uterine carcinosarcoma with improved survival and increased immunogenicity. J Clin Oncol. 2021;39(Suppl 15)5588.
32. 32. Chiang C-Y, Huang H-J, Chang W-Y, et al. Adjuvant therapy and prognosis in uterine carcinosarcoma. J Formos Med Assoc. 2021;120:1977-1987.