A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma

Elizabeth L. Dickson; Rachel Isaksson Vogel; Paola A. Gehrig; Stuart Pierce; Laura Havrilesky; Angeles Alvarez Secord; Joseph Dottino; Amanda N. Fader; Stephanie Ricci; Melissa A. Geller

doi:10.1016/j.ygyno.2015.09.002

A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma

Elizabeth L. Dickson, Rachel Isaksson Vogel, Paola A. Gehrig, Stuart Pierce, Laura Havrilesky, Angeles Alvarez Secord, Joseph Dottino, Amanda N. Fader, Stephanie Ricci, Melissa A. Geller

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	275-282
Number of pages	8
Journal	Gynecologic oncology
Volume	139
Issue number	2
DOIs	https://doi.org/10.1016/j.ygyno.2015.09.002
State	Published - 2015

Bibliographical note

Funding Information:
Dr. Dickson, Dr. Geller and Ms. Isaksson Vogel report funding from the National Institutesof Health during the study period. The other authors declare that there are no conflicts ofinterest.Funding statementThis research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics andBioinformatics Core shared resource of theMasonic Cancer Center, Universityof Minnesota and by the National Center for Advancing TranslationalSciences of the National Institutes of Health Award NumberUL1TR000114. The content is solely the responsibility of the authorsand does not necessarily represent the official views of the National Institutesof Health.This researchwas presented as an oral plenary session at the Societyof Gynecologic Oncology annual meeting on March 25th, 2013.

Funding Information:
This research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

Chemotherapy
MMMT
Multimodal therapy
Radiation
Survival
Uterine carcinosarcoma

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A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma. / Dickson, Elizabeth L.; Vogel, Rachel Isaksson; Gehrig, Paola A.; Pierce, Stuart; Havrilesky, Laura; Secord, Angeles Alvarez; Dottino, Joseph; Fader, Amanda N.; Ricci, Stephanie; Geller, Melissa A.

In: Gynecologic oncology, Vol. 139, No. 2, 2015, p. 275-282.

Research output: Contribution to journal › Article › peer-review

@article{24bdb7e70c8043a3a561026e909062b4,

title = "A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma",

abstract = "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.",

keywords = "Chemotherapy, MMMT, Multimodal therapy, Radiation, Survival, Uterine carcinosarcoma",

author = "Dickson, {Elizabeth L.} and Vogel, {Rachel Isaksson} and Gehrig, {Paola A.} and Stuart Pierce and Laura Havrilesky and Secord, {Angeles Alvarez} and Joseph Dottino and Fader, {Amanda N.} and Stephanie Ricci and Geller, {Melissa A.}",

note = "Funding Information: Dr. Dickson, Dr. Geller and Ms. Isaksson Vogel report funding from the National Institutesof Health during the study period. The other authors declare that there are no conflicts ofinterest.Funding statementThis research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics andBioinformatics Core shared resource of theMasonic Cancer Center, Universityof Minnesota and by the National Center for Advancing TranslationalSciences of the National Institutes of Health Award NumberUL1TR000114. The content is solely the responsibility of the authorsand does not necessarily represent the official views of the National Institutesof Health.This researchwas presented as an oral plenary session at the Societyof Gynecologic Oncology annual meeting on March 25th, 2013. Funding Information: This research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ",

year = "2015",

doi = "10.1016/j.ygyno.2015.09.002",

language = "English (US)",

volume = "139",

pages = "275--282",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

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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 - Funding Information: Dr. Dickson, Dr. Geller and Ms. Isaksson Vogel report funding from the National Institutesof Health during the study period. The other authors declare that there are no conflicts ofinterest.Funding statementThis research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics andBioinformatics Core shared resource of theMasonic Cancer Center, Universityof Minnesota and by the National Center for Advancing TranslationalSciences of the National Institutes of Health Award NumberUL1TR000114. The content is solely the responsibility of the authorsand does not necessarily represent the official views of the National Institutesof Health.This researchwas presented as an oral plenary session at the Societyof Gynecologic Oncology annual meeting on March 25th, 2013. Funding Information: This research was supported by the NIH T-32 training grant 5T32-CA132715 and NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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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