Introduction Uterine carcinosarcoma (UCS) is a highly aggressive, rare, biphasic tumor.Lymph node evaluation by either lymphadenectomy (LND) or sentinel lymph node biopsy(SLNB) is recommended. However, its value in late-stage disease remains unclear.
Methods Clinical data of patients with UCS from four different hospitals between February 2006 and December 2021 were reviewed. Patients with prior radiotherapy and/or chemotherapy were excluded. Progression-free survival (PFS) and overall survival (OS) were determined.
Results Among 103 UCS patients, 91 UCS patients had enough follow-up data. 47 (51.6%) were diagnosed at stage III-IV, among which 24 (51.1%) had LND. 16 patients (34.0%) had lymph node metastases (LNM). Patients undergoing LND was associated with longer median PFS (20.2 months vs. 5.7 months, P = 0.009) and OS (29.1 months vs. 14.1 months, P < 0.009) compared to those without LND. Multivariate analyses demonstrated that LND (hazard ratio, HR 0.447, 95% confidence interval (CI) 0.23 – 0.86, P = 0.-16) and chemotherapy (HR 0.070, 95% CI 0.03 – 0.19, P < 0.001) were significant prognostic factors for PFS in late-stage patients. Additionally, LND (HR 0.133, 95% CI 0.04 – 0.50, P =0.003) and chemotherapy (HR 0.102, 95% CI 0.03 – 0.33, P < 0.001) were independent significant prognostic factors for OS.
Conclusion/Implications Despite the use of adjuvant therapy, LND remains an integral part of the surgical treatment. Further prospective studies are needed to elucidate its value in late-stage disease.
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