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Abstract
Objectives To evaluate differences in survival and recurrence patterns in stage I-IV uterine carcinosarcoma (UCS) patients treated with surgery followed by adjuvant chemotherapy (CT), radiation (RT) or both (chemoRT).
Methods A multicenter retrospective analysis of patients with surgically staged UCS receiving adjuvant therapy from 2000 to 2019 was conducted. Sites of recurrence were analyzed by adjuvant treatment modality using Pearson’s χ2-test. PFS and OS were calculated using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model.
Results Of 176 evaluable patients, 27% had stage I, 14% stage II, 37% stage III and 22% stage IV disease. Among them, 33% received CT 17% received RT, and 50% received chemoRT. Stage I recurred less frequently (64%) vs. II (83%), III (85%) and IV (90%)(p<0.001). Patients receiving CT were more likely to recur in the pelvis vs. RT-containing regimens (p=0.06) and abdominal recurrences were more common with RT-alone (p=0.07). Stage I demonstrated improved PFS and OS relative to all other stages (p<0.01). Patients receiving chemoRT experienced superior PFS (p=0.01) and OS (p=0.05) vs. single modality therapy. Stage III derived the greatest improvement in PFS and OS from chemoRT (p<0.01). On MVA, only stage (p<0.01) and receipt of chemoRT (p=0.04) independently predicted survival.
Overall survival (OS) based on Kaplan-meier estimatesA: OS based on FIGO stage; B: OS of all stages based on the type of adjuvant theraphy; C: OS of stage III disease based on the type of adjuvant theraphy
Conclusions The majority of UCS patients recur in 2–3 years despite aggressive adjuvant therapy. Stage I disease demonstrated improved survival compared to other stages regardless of adjuvant treatment modality. ChemoRT was associated with improved survival and better distant and local disease control. Stage III disease derived the most significant benefit from chemoRT.