TY - JOUR
T1 - A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma
AU - Dickson, Elizabeth L.
AU - Vogel, Rachel Isaksson
AU - Gehrig, Paola A.
AU - Pierce, Stuart
AU - Havrilesky, Laura
AU - Secord, Angeles Alvarez
AU - Dottino, Joseph
AU - Fader, Amanda N.
AU - Ricci, Stephanie
AU - Geller, Melissa A.
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015
Y1 - 2015
N2 - Objective To evaluate the use of adjuvant therapy after primary surgery for stage I-III uterine carcinosarcoma (CS). Methods A multi-institutional retrospective study of women with stage I-III CS was conducted. Analyses were stratified by stage (I/II and III). Patients were categorized according to adjuvant therapy: observation (OBS), radiation (RT), chemotherapy (CT) or multimodal therapy (CT + RT). Overall survival (OS) and progression-free survival (PFS) were analyzed using log-rank tests and Cox proportional hazards models. Results 303 patients were identified across four institutions: 195 with stage I/II and 108 with stage III disease. In stage I/II disease, 75 (39.9%) received OBS, 33 (17.6%) CT, 37 (19.7%) RT, and 43 (22.9%) CT + RT. OBS was associated with a fourfold increased risk of death compared to CT (adjusted hazard ratio (aHR) = 4.48, p = 0.003). Patients receiving CT + RT had significantly improved PFS compared to those receiving CT alone (aHR = 0.43, p = 0.04), but no difference in OS. In the stage III cohort, 16 (15.0%) received OBS, 34 (31.8%) CT, 20 (18.7%) RT, and 37 (34.6%) CT + RT. OBS was associated with worse OS and PFS compared to CT (OS: aHR = 2.46, p = 0.04; PFS: aHR = 2.39, p = 0.03, respectively). A potential improvement in PFS was seen for those treated with CT + RT compared to CT alone, however it was not statistically significant (aHR = 0.53, p = 0.09). Conclusions Observation after surgery was associated with poor outcomes in uterine CS compared to CT and RT alone. Multimodality therapy for women with stage I/II disease was associated with improved PFS compared to chemotherapy alone. Novel treatment options are needed to improve outcomes in this aggressive disease.
AB - Objective To evaluate the use of adjuvant therapy after primary surgery for stage I-III uterine carcinosarcoma (CS). Methods A multi-institutional retrospective study of women with stage I-III CS was conducted. Analyses were stratified by stage (I/II and III). Patients were categorized according to adjuvant therapy: observation (OBS), radiation (RT), chemotherapy (CT) or multimodal therapy (CT + RT). Overall survival (OS) and progression-free survival (PFS) were analyzed using log-rank tests and Cox proportional hazards models. Results 303 patients were identified across four institutions: 195 with stage I/II and 108 with stage III disease. In stage I/II disease, 75 (39.9%) received OBS, 33 (17.6%) CT, 37 (19.7%) RT, and 43 (22.9%) CT + RT. OBS was associated with a fourfold increased risk of death compared to CT (adjusted hazard ratio (aHR) = 4.48, p = 0.003). Patients receiving CT + RT had significantly improved PFS compared to those receiving CT alone (aHR = 0.43, p = 0.04), but no difference in OS. In the stage III cohort, 16 (15.0%) received OBS, 34 (31.8%) CT, 20 (18.7%) RT, and 37 (34.6%) CT + RT. OBS was associated with worse OS and PFS compared to CT (OS: aHR = 2.46, p = 0.04; PFS: aHR = 2.39, p = 0.03, respectively). A potential improvement in PFS was seen for those treated with CT + RT compared to CT alone, however it was not statistically significant (aHR = 0.53, p = 0.09). Conclusions Observation after surgery was associated with poor outcomes in uterine CS compared to CT and RT alone. Multimodality therapy for women with stage I/II disease was associated with improved PFS compared to chemotherapy alone. Novel treatment options are needed to improve outcomes in this aggressive disease.
KW - Chemotherapy
KW - MMMT
KW - Multimodal therapy
KW - Radiation
KW - Survival
KW - Uterine carcinosarcoma
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U2 - 10.1016/j.ygyno.2015.09.002
DO - 10.1016/j.ygyno.2015.09.002
M3 - Article
C2 - 26348313
AN - SCOPUS:84952629118
SN - 0090-8258
VL - 139
SP - 275
EP - 282
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -