Introduction/Background*Owing to scarce and small-sampled studies from India about uterine carcinosarcomas, we embarked on this retrospective study, to assess clinicopathologic factors, treatment and recurrence patterns and to ascertain survival outcomes of these cancers.
Methodology Retrospective analysis of all patients who presented to our tertiary care cancer centre with a diagnosis of carcinosarcoma of female genital tract between January 2004 and December 2018. Clinicopathological features, treatment details, follow-up, recurrence and survival were collected from medical records. Chi-square test and Fisher Exact test were used to compare categorical data. Overall and disease-free survival (OS and DFS) were calculated using the Kaplan-Meier method and significance calculated by log rank test.
Result(s)*101 patients presented with diagnosis of female genital tract carcinosarcoma during the study period. Of these 83 (81.8%) were uterine, 12 ovarian, 2 cervical, 3 vaginal and one of unknown origin. Median OS for uterine tumours was 44 months whereas for ovarian, cervical and vaginal were 22, 17and 23 months, respectively(p=.080). Due to small numbers of extrauterine carcinosarcomas, only uterine lesions were further analysed. Of 62 analysable uterine carcinosarcomas, 61.3% had early stage disease (stage I) and 38.7% had advanced disease. 18% had nodal involvement. On follow up, there were 12 patients with locoregional recurrences and 18 with distant metastases. Histology of carcinosarcoma with homologous elements had more survival, although non-significant than those with heterologous or rhabdomyosarcoma (45 vs 30 or 18 months).
With a median follow up of 63 months, median OS was 44 months and DFS of 23 months. Lymph node involvement and lack of primary surgery had a dismal survival of only 4 months each. Stagewise OS – Stage IA- 101 months, IB-44, II-30, IIIA/B- 34, IIIC- 4, IV-12 months. In stage IIIC disease, chemotherapy with radiotherapy conferred better OS than chemo alone (36 months vs 4 months, p =0.006).
Conclusion*Non-uterine carcinosarcomas had poorer survival than their uterine counterparts. Our cohort of uterine carcinosarcomas had more patients with early-stage disease.. Nodal involvement carries poor prognosis. On subgroup survival analysis, adjuvant radiation in combination with chemotherapy showed benefit, with significant effect seen in stage III cancers.
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