Survival analysis of patients with rare tumors of the uterine corpus – carcinosarcomas
Abstract
Background/Aim. Uterine carcinosarcoma (UCS), formerly known as malignant mixed Müllerian tumor, is a rare, aggressive malignancy of the female genital tract. The aim of this study was to analyze the most important clinical and pathohistological characteristics of UCSs on operated patients, as well as to determine which of those factors are affecting progression-free survival (PFS) and overall survival (OS) of patients. Methods. The study was conducted as a retrospective analysis of medical data documentation of patients with a diagnosis of UCS who were surgically treated at the Department of Gynecology, Clinic for Operative Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia, in 10 years’ period (from the beginning of 2009 to the end of 2018). The analysis included data for a total of 31 patients. Results. Of all the examined parameters (age of the patient, clinical stage of the disease, histological grade, depth of myometrial invasion, and lymphovascular invasion – LVI), the greatest influence on the choice of therapeutic procedure had a histological tumor grade. Conclusion. Our research showed the joint influence of the examined clinical and pathohistological factors on PFS and OS of patients with UCS. The only independent parameter that showed a statistically significant impact on survival is LVI.
References
Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol 2015; 137(3): 581–8.
Pezzicoli G, Moscaritolo F, Silvestris E, Silvestris F, Cormio G, Porta C, et al. Uterine carcinosarcoma: An overview. Crit Rev Oncol Hematol 2021; 163: 103369.
Van der Horst RL, Van der Hel O, Lutgens L, Van der Aa M, Slangen B, Kruitwagen R, et al. The role of multimodal adjuvant therapy for FIGO I-II carcinosarcoma of the uterus: a system-atic review. Crit Rev Oncol Hematol 2022; 175: 103701.
Kathan R, Senger JL. Uterine carcinosarcomas (malignant mixed müllerian tumours): a review with special emphasis on the controversies in management. Obstet Gynecol Int 2011; 2011: 470795.
Chandrasekaran A, Kumar A, Kumar T, Chauhan A, Kaur P, Khurana A. Malignant mixed Mullerian tumour (MMMT) of uterus: Rare and aggressive tumor. J Clin Med Res 2019; 7(3): 267–9.
Denschlag D, Ulrich UA. Uterine Carcinosarcomas - Diagnosis and Management. Oncol Res Treat 2018; 41(11): 675–9.
Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer 2000; 88(12): 2782–6.
Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carci-noma and sarcoma components on survival outcomes of uter-ine carcinosarcoma. Ann Oncol 2016; 27(7): 1257–66.
Lopez-Garcia MA, Palacios J. Pathologic and molecular features of uterine carcinosarcomas. Semin Diagn Pathol 2010; 27(4): 274–86.
McCluggage WG. Malignant biphasic uterine tumours: carcino-sarcomas or metaplastic carcinomas? J Clin Pathol 2002; 55(5): 321–5.
Emoto M, Iwasaki H, Ishiguro M, Kikuchi M, Horiuchi S, Saito T, et al. Angiogenesis in carcinosarcomas of the uterus: Differ-ences in the microvessel density and expression of vascular endothelial growth factor between the epithelial and mesen-chymal elements. Hum Pathol 1999; 30(10): 1232–41.
De Jong RA, Nijman HW, Wijbrandi TF, Reyners AK, Boezen HM, Hollema H. Molecular markers and clinical behavior of uterine carcinosarcomas: focus of the epithelial tumour component. Mod Pathol 2011; 24(10): 1368–79.
Şükür YE, Taşkın S, Varlı B, Ateş C, Güngör M, Ortaç F. Prog-nostic factors for disease-free and overall survival of patients with uterine carcinosarcoma. Int J Clin Oncol 2018; 23(1): 114–20.
Zwahlen DR, Schick U, Bolukbasi Y, Thariat J, Abdah-Bortnyak R, Kuten A, et al. Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study. Rare Tumors 2016; 8(2): 6052.
Rojas C, Tian C, Powell MA, Chan JK, Bateman NW, Conrads TP, et al. Racial disparities in uterine and ovarian carcinosarcoma: A population-based analysis of treatment and survival. Gynecol Oncol 2020; 157(1): 67–77.
Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynae-col Obstet 2018; 143(Suppl 2): 51–8.
Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol 2015; 94(1): 98–104.
Cory L, Brensinger C, Burger RA, Giuntoli RL, Morgan MA, Latif N, et al. Patterns of adjuvant treatment and survival outcomes in stage I uterine carcinosarcoma, Gynecol Oncol Rep 2022; 39: 100930.
Beckmann K, Selva-Nayagam S, Olver I, Miller C, Buckley ES, Powell K, et al. Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment. Cancer Manag Res 2021; 13: 4633–45.
Bodner-Adler B, Bodner K, Obermair A, Czerwenka K, Petru E, Leodolter S, et al. Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study. Anticancer res 2001; 21(4B): 3069–74.
Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B. Uterine Sarcoma: Analysis of 13,089 Cases Based on Surveillance, Epidemiology, and End Results Database. Int J Gynecol Cancer 2016; 26(6): 1098–104.
McEachron J, Heyman T, Shanahan L, Tran V, Friedman M, Gorelick C, et al. Multimodality adjuvant therapy and survival outcomes in stage I–IV uterine carcinosarcoma. Int J Gynecol Cancer 2020; 30(7): 1012–7.
Terblanche L, Botha MH. Uterine carcinosarcoma: A 10-year single institution experience. PLoS One 2022; 17(7): e0271526.
Hapsari K, Bhugwandass C, Van Rijn GWJ, Van der Wurff AAM, Van ‘t Veer M, Boll D, et al. Treatment and Outcome of Patients with Uterine Carcinosarcoma in a Comprehensive Cancer Network. Indian J Gynecol Oncol 2020; 18: 17.
Kurnit KC, Previs RA, Soliman PT, Westin SN, Klopp AH, Fellman BM, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol 2019; 152(1): 31–7.
Nama N, Cason FD, Misra S, Hai S, Tucci V, Haq F, et al. Car-cinosarcoma of the Uterus: A Study From the Surveillance Epidemiology and End Result (SEER) Database. Cureus 2020; 12(9): e10283.
Dave KS, Chauhan A, Bhansali R, Arora R, Purohit S. Uterine carcinosarcomas: 8-year single center experience of 25 cases. Indian J Med Paediatr Oncol 2011; 32(3): 149–53.
Pautier P, Genestie C, Rey A, Morice P, Roche B, Lhommé C, et al. Analysis of clinicopathologic prognostic factors for 157 uter-ine sarcomas and evaluation of a grading score validated for soft tissue sarcoma. Cancer 2000; 88(6): 1425–31.
Yilmaz U, Alanyali S, Aras AB, Ozsaran Z. Adjuvant radiotherapy for uterine carcinosarcoma: A retrospective assessment of treatment outcomes. J Cancer Res Ther 2019; 15(6): 1377–82.
Corrado G, Ciccarone F, Cosentino F, Legge F, Rosati A, Arcieri M, et al. Role of minimally invasive surgery versus open approach in patients with early-stage uterine carcinosarcomas: a retrospective multicentric study. J Cancer Res Clin Oncol 2021; 147(3): 845–52.
Toboni MD, Crane EK, Brown J, Shushkevich A, Chiang S, Slo-movitz BM, et al. Uterine carcinosarcomas: From pathology to practice. Gynecol Oncol 2021; 162(1): 235–41.
Moatasim A, Hameed Z, Ahmad I. Assessment of lymphovascu-lar invasion in early stage endometrial carcinoma- a retrospec-tive study. Surg Exp Pathol 2021; 4: 9.
Gonzalez Bosquet J, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol 2010; 116(3): 419–23.
Gunther JR, Christensen EN, Allen PK, Ramondetta LM, Jhingran A, Fleming ND, et al. Role of Radiation Therapy in the Multi-disciplinary Management of Uterine Carcinosarcoma. Int J Gynecol Cancer 2018; 28(1): 114–21.
Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ. Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 2004; 58(3): 786–96.
Patel N, Hegarty SE, Cantrell LA, Mishra MV, Showalter TN. Evaluation of brachytherapy and external beam radiation therapy for early stage, node-negative uterine carcinosarcoma. Brachytherapy 2015; 14(5): 606–12.
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 2020; 160(2): 586–601.