Dave Kalpana S, Chauhan Anjana, Bhansali Ronak, Arora Ruchi, Purohit Sushma
Department of Gynecology Oncology, Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India.
Indian J Med Paediatr Oncol. 2011 Jul;32(3):149-53. doi: 10.4103/0971-5851.92814.
The aim of this retrospective study was to evaluate the behavior and treatment outcomes of uterine carcinosarcomas in relation to their clinical and pathogenic features and to determine the optimal treatment strategy. Secondary objectives were to identify parameters predictive of survival.
The hospital records of all 25 patients of uterine carcinosarcoma operated between 2000 and 2008 in Gujarat cancer research institute, Ahmedabad, were reviewed. Patients who presented with clinical evidence of recurrent disease or those who had incomplete medical records were excluded from our analysis. The status of these patients was updated up to November, 2010. Patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma, to see what difference the assigned stage has on survival with the old treatment strategy. Survival was calculated by Kaplan-Meier method and compared by Log-Rank test. Median survival time was derived with the Brookmeyer 95% confidence interval. For comparison of qualitative data, Chi-Square test and Fisher extract χ(2) were used.
Median age of patients was 56 years (range, 36-77 years). Only 36% of patients had stage I at diagnosis and another 36% were stage III. Most of the tumors (56%) were with homologous sarcomatous components and 64% of tumors were high grade (grade 2/3) at diagnosis. Fifty-two percent patients received postoperative adjuvant treatment. Twelve patients had no postoperative treatment: two were lost to follow-up immediately after surgery, four could not receive adjuvant treatment on account of severe medical complications and age factor which could have increased morbidity, and six patients declined treatment. Four of these patients expired within one year of diagnosis, two other within 18 months, and rest were lost to follow-up. The difference in survival of 13 patients who had taken adjuvant treatment was significantly more than the group who had not taken adjuvant therapy (P=0.025). The overall 3-year disease-free survival of 13 patients who had taken adjuvant therapy was 40%. However, these adjuvant treatment modalities had borderline statistical significance on overall survival of patients (P=0.075). The only statistically significant predictor of survival in this study was stage of the disease (P=0.035).
This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systematic adjuvant therapy in patients with both early and advanced disease. The value of pelvic Radiotherapy in addition to systemic treatment remains ill-defined. Stage is the significant predictor of survival for the disease. Our results indicate that in this highly aggressive malignancy, further exploration of potential outcome benefits of postoperative treatment, especially chemoradiation, is warranted in larger group of patients after comprehensive surgical staging.
本回顾性研究旨在评估子宫癌肉瘤的行为及治疗结果与其临床和致病特征的关系，并确定最佳治疗策略。次要目的是确定预测生存的参数。
回顾了2000年至2008年在艾哈迈达巴德古吉拉特癌症研究所接受手术的25例子宫癌肉瘤患者的医院记录。有复发疾病临床证据或病历不完整的患者被排除在分析之外。这些患者的状况更新至2010年11月。根据2009年子宫内膜癌新的国际妇产科联盟（FIGO）分期系统对患者进行分类，以观察指定分期对旧治疗策略下生存的影响。采用Kaplan-Meier法计算生存率，并通过对数秩检验进行比较。中位生存时间通过Brookmeyer 95%置信区间得出。对于定性数据的比较，使用卡方检验和Fisher精确χ²检验。
患者的中位年龄为56岁（范围36 - 77岁）。仅36%的患者诊断时为I期，另有36%为III期。大多数肿瘤（56%）具有同源性肉瘤成分，64%的肿瘤在诊断时为高级别（2/3级）。52%的患者接受了术后辅助治疗。12例患者未接受术后治疗：2例术后立即失访，4例因严重医疗并发症和年龄因素可能增加发病率而无法接受辅助治疗，6例患者拒绝治疗。这些患者中有4例在诊断后1年内死亡，另外2例在18个月内死亡，其余失访。接受辅助治疗的13例患者与未接受辅助治疗的患者相比，生存差异有统计学意义（P = 0.025）。接受辅助治疗的13例患者的3年总体无病生存率为40%。然而，这些辅助治疗方式对患者总体生存的统计学意义接近临界值（P = 0.075）。本研究中唯一具有统计学意义的生存预测因素是疾病分期（P = 0.035）。
这种具有高度侵袭性的子宫恶性肿瘤需要进行全面的手术分期以评估肿瘤播散情况，随后对早期和晚期疾病患者进行系统的辅助治疗。除全身治疗外盆腔放疗的价值仍不明确。分期是该疾病生存的重要预测因素。我们的结果表明，在这种具有高度侵袭性的恶性肿瘤中，在全面手术分期后对更大规模患者群体进一步探索术后治疗，尤其是放化疗的潜在疗效益处是有必要的。
