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Patterns of Failure for Conservatively Managed Surgical Stage I Uterine Carcinosarcoma: Implications for Adjuvant Therapy
  1. III Charles A. Leath, MD*,
  2. T. Michael Numnum, MD*,
  3. IV James E. Kendrick, MD*,
  4. Peter J. Frederick, MD*,
  5. Rodney P. Rocconi, MD*,
  6. Michael G. Conner, MD and
  7. Jr J. Michael Straughn, MD*
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and
  2. Department of Pathology, University of Alabama at Birmingham, Birmingham, AL.
  1. Address correspondence and reprint requests to Charles A. Leath, III, MD, Department of Obstetrics and Gynecology, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234. E-mail: Trey_Leath@yahoo.com; charles.leath{at}amedd.army.mil.

Abstract

To evaluate patterns of failure and overall survival for patients with surgical stage I uterine carcinosarcoma managed conservatively without adjuvant therapy. A computerized database identified 27 patients whose conditions have been diagnosed with surgical stage I uterine carcinosarcoma from 1993 to 2002. Charts were abstracted for patient demographics, tumor characteristics, recurrence, and survival. Of 27 patients, 23(85%) did not receive adjuvant therapy after undergoing total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy. Five patients were stage IA, 14 were stage IB, and 4 were stage IC. Fourteen patients had either poorly differentiated endometrioid carcinoma alone or in combination with papillary serous carcinoma (61%) as their epithelial tumor component. The median nodal count was 9 (range, 3-21). Eleven patients are alive without evidence of disease with a median follow-up of 63 months (range, 12-164 months). Eleven patients had recurrence with a median time to recurrence of 13 months (range, 6-39 months), and all are dead of disease. Univariate analysis demonstrated that poorly differentiated epithelial or papillary serous histologic diagnosis was the only predictor variable associated with recurrence and, consequently, death (P = 0.04). Approximately 50% of patients with surgical stage I carcinosarcoma who are observed without adjuvant therapy will experience a recurrence. Because most patients will recur distantly, systemic chemotherapy should be considered for patients with early stage uterine carcinosarcoma.

  • Uterine carcinosarcoma
  • Mixed mesodermal tumor
  • Surgical staging
  • Outcomes

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Footnotes

  • Oral presentation at the Armed Forces District Annual Meeting of the American College of Obstetricians and Gynecologists, Sonthofen, Germany, October 2006.

  • The opinion or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Air Force or the Department of Defense.

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