Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma

Koji Matsuo, Kohei Omatsu, Malcolm S. Ross, Marian S. Johnson, Mayu Yunokawa, Merieme M. Klobocista, Dwight D. Im, Stephen H. Bush, Yutaka Ueda, Tadao Takano, Erin A. Blake, Kosei Hasegawa, Tsukasa Baba, Masako Shida, Shinya Satoh, Takuhei Yokoyama, Hiroko Machida, Sosuke Adachi, Yuji Ikeda, Keita IwasakiTakahito M. Miyake, Shiori Yanai, Masato Nishimura, Tadayoshi Nagano, Munetaka Takekuma, Satoshi Takeuchi, Tanja Pejovic, Mian MK Shahzad, Frederick R. Ueland, Joseph L. Kelley, Lynda D. Roman

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Background To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern. Methods We examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns. Results The most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25–0.83, P = 0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27–0.62, P < 0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13–1.58, P = 0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P < 0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02–0.90; P = 0.013) but not in none/single factor (P = 0.36). Conclusion Adjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.

Original languageEnglish (US)
Pages (from-to)78-87
Number of pages10
JournalGynecologic oncology
Volume145
Issue number1
DOIs
StatePublished - Apr 1 2017

Keywords

  • Chemotherapy
  • Radiotherapy
  • Recurrence
  • Stage I
  • Survival outcome
  • Uterine carcinosarcoma

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Matsuo, K., Omatsu, K., Ross, M. S., Johnson, M. S., Yunokawa, M., Klobocista, M. M., Im, D. D., Bush, S. H., Ueda, Y., Takano, T., Blake, E. A., Hasegawa, K., Baba, T., Shida, M., Satoh, S., Yokoyama, T., Machida, H., Adachi, S., Ikeda, Y., ... Roman, L. D. (2017). Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecologic oncology, 145(1), 78-87. https://doi.org/10.1016/j.ygyno.2017.02.001