Ferguson Sarah E, Tornos Carmen, Hummer Amanda, Barakat Richard R, Soslow Robert A
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Am J Surg Pathol. 2007 Nov;31(11):1653-61. doi: 10.1097/PAS.0b013e3181161ba3.
Uterine carcinosarcomas (CSs) are aggressive neoplasms, with 5-year overall survival (OS) rates of less than 35%. They are customarily separated into types harboring either heterologous or homologous mesenchymal elements, but the prognostic significance of this finding is controversial. Our goal was to study clinicopathologic features of possible prognostic relevance in surgical stage I uterine CS. A retrospective clinical and histopathologic review was performed for all women diagnosed with surgical stage I uterine CS. These tumors were compared with stage I high-grade endometrial (HGEm) carcinomas for clinical outcomes. There were 42 cases of surgical stage I uterine CS identified between January 1990 and January 2004. The disease-free survival and OS rates for patients with stage I CS were significantly worse compared with stage I HGEm (P=0.001; P=0.01). The median disease-free survival for patients with heterologous CS was 15 months and had not been reached for women with homologous CS (P=0.001). The 3-year OS rates were 45% versus 93% in women with heterologous compared with homologous stage I CS (P<0.001). The 3-year OS rates for homologous CS and HGEm were both >90%. Homologous stage I CSs have survival outcomes that are similar to HGEm. This further supports the concept that homologous stage I CSs are carcinomas with sarcomatoid features, not sarcomas. More importantly, the presence of heterologous sarcomatous elements is a powerful negative prognostic factor in surgical stage I uterine CS.
子宫癌肉瘤（CSs）是侵袭性肿瘤，5年总生存率（OS）低于35%。它们通常被分为含有异源性或同源性间叶成分的类型，但这一发现的预后意义存在争议。我们的目标是研究手术分期为I期的子宫CS中可能具有预后相关性的临床病理特征。对所有诊断为手术分期为I期子宫CS的女性进行了回顾性临床和组织病理学检查。将这些肿瘤与I期高级别子宫内膜（HGEm）癌的临床结局进行比较。1990年1月至2004年1月期间共确诊42例手术分期为I期的子宫CS。I期CS患者的无病生存率和总生存率与I期HGEm相比显著更差（P = 0.001；P = 0.01）。异源性CS患者的无病生存期中位数为15个月，同源性CS女性未达到（P = 0.001）。I期异源性CS女性与同源性CS女性相比，3年总生存率分别为45%和93%（P < 0.001）。同源性CS和HGEm的3年总生存率均>90%。同源性I期CS的生存结局与HGEm相似。这进一步支持了同源性I期CS是具有肉瘤样特征的癌而非肉瘤的概念。更重要的是，异源性肉瘤成分的存在是手术分期为I期子宫CS的一个强大的负面预后因素。
