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#534 Prognosis of surgically staged FIGO IA uterine carcinosarcoma without myometrial invasion: a multicenter international retrospective cohort study
  1. Giuseppe Cucinella1,2,
  2. William A Zammarrelli3,
  3. Dimitrios Nasioudis4,
  4. Ilaria Capasso1,5,
  5. Roberto Berretta6,
  6. Paolo Scollo7,8,
  7. Raspagleisi Francesco9,
  8. Glauco Baiocchi10,
  9. Giuseppe Barresi11,
  10. Pecorino Basilio7,
  11. Giorgio Bogani9,
  12. Bruna Tirapelli Goncalves10,
  13. Maryam Shahi12,
  14. Angela J Fought13,
  15. Michaela E Mcgree13,
  16. Vito Chiantera2,
  17. Francesco Fanfani5,
  18. Giovanni Scambia5,
  19. Nadeem R Abu-Rustum3,
  20. Andrea Mariani1,
  21. Robert Giuntoli14,
  22. Gretchen Glaser1 and
  23. Mario M Leitao3
  1. 1Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Mn, USA
  2. 2Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
  3. 3Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, Ny, USA
  4. 4University of Pennsylvania Health System, Philadelphia. Pa, USA
  5. 5UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  6. 6Department of medicine and surgery, University Hospital of Parma,, Parma, Italy
  7. 7Division of Gynecology and Obstetrics, Cannizzaro Hospital, Catania, Italy
  8. 8Kore University, Enna, Italy
  9. 9Fondazione IRCCS Istituto Nazionale Tumori-Milan, Milan, Italy
  10. 10A.C. Camargo Cancer Center, Sao Paulo, Brazil
  11. 11Department of medicine and surgery, University Hospital of Parma,, Parma, Italy, Parma, Italy
  12. 12Department of Pathology, Mayo Clinic, Rochester, Mn, USA
  13. 13Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Mn, USA
  14. 14University of Pennsylvania Health System, Philadelphia, Pa, USA


Introduction/Background Uterine carcinosarcoma (CS) is a rare cancer with poor prognosis. CS without myometrial invasion (MI), such as limited to the endometrial lining/polyp or with no residual uterine disease at the time of hysterectomy is extremely uncommon. The oncologic outcomes of these patients are poorly understood and there is no consensus on standard of care. Therefore, the study aims to evaluate the long-term outcomes of CS patients without MI.

Methodology Patients with FIGO stage IA CS limited to the endometrial lining/polyp or without residual uterine disease were identified from 9 centers worldwide between 12/1998 and 1/2023. Patients who underwent surgical staging (hysterectomy, bilateral salpingo-oophorectomy, bilateral lymph node assessment (sentinel or systematic lymphadenectomy)) were included. Patients were excluded if adjuvant therapy was unknown. Survival analysis follow-up was limited to the first 10 years after surgery.

Results Of 84 patients included, 21 (25.0%) had disease confined to a polyp, 50 (59.5%) to the endometrial lining, and 13 (15.5%) had no residual disease in the hysterectomy specimen. Patients received observation (n=12 [14.3%]), vaginal brachytherapy (VB) alone (n=13 [15.5%]), EBRT±VB (n=4 [4.8%]), or chemotherapy ±EBRT±VB (n=55 [65.5%]). Twenty-seven patients (32.1%) recurred. Five-year recurrence-free survival (RFS) was 63.9% (95% CI, 53.2–76.7%); median follow-up for patients without recurrence was 4.6 years (interquartile range, 1.9–6.1). No significant difference was observed in RFS between patients in the three groups (p=0.60, figure 1A). Five-year overall survival (OS) was 73.0% (95% CI, 62.9–84.8%), and was also not significantly different between groups (p=0.12, figure 1B). Univariate analysis showed no significant differences in RFS and OS by postoperative treatment.

Abstract #534 Figure 1

Recurrence-free survival (A) and overall survival (B) Kaplan Meier curves stratified by tumor location: no residual in the uterine specimen, confined to polyp, limited to endometrium.

Conclusion Patients with stage IA CS without MI have a relatively high recurrence rate. Even in patients with no MI or no residual tumor at the time of hysterectomy, prognosis is unfavorable. While caution must be exercised in withholding adjuvant therapy, the optimal treatment remains unclear.

Disclosures NO disclosures

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