Department of Gynecologic Oncology and Reproductive Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, United States of America.
Gynecol Oncol. 2019 Jan;152(1):31-37. doi: 10.1016/j.ygyno.2018.10.034. Epub 2018 Nov 8.
Evaluate the impact of clinicopathologic characteristics and adjuvant treatment on survival outcomes in early stage uterine carcinosarcoma patients.
We performed a retrospective cohort study of women with stage I or II uterine carcinosarcoma at our institution between March 1990 and June 2016. All pathology had been reviewed and confirmed by gynecologic pathologists. Data were extracted from the electronic medical record. Descriptive and comparative statistics were used to compare clinicopathologic characteristics. Univariable and multivariable analyses were performed for survival outcomes.
140 patients were identified. Median age was 67 years (range: 36-91). Median follow-up was 39.1 months (2.9-297.4). The majority of patients had stage IA (67%) versus stage IB (21%) or stage II (11%) disease. The majority of patients (63%) received adjuvant treatment: vaginal brachytherapy only (14%); whole pelvic radiation therapy only (16%); chemotherapy only (n = 13, 9%); combination chemotherapy and vaginal brachytherapy (15%); combination chemotherapy and whole pelvic radiation (9%). 52 patients (37%) received no adjuvant therapy. Median overall survival (OS) was 48.0 months (95% CI 32.7-80.9). On multivariable analysis for OS, advancing age (HR 1.05, 95% CI 1.03-1.08, p < 0.001), higher stage (stage IB: HR 1.64, 95% CI 0.91-2.95, p = 0.10; stage II: HR 3.04, 95% CI 1.51-6.13, p = 0.002), and the presence of a rhabdomyosarcoma component (HR 1.66, 95% CI 1.02-2.70, p = 0.04) were significantly associated with worse OS.
Advancing age, stage, and the presence of a rhabdomyosarcoma component were all associated with worse OS in patients with early stage uterine carcinosarcoma. New treatment algorithms should incorporate factors aside from stage alone.
评估临床病理特征和辅助治疗对早期子宫癌肉瘤患者生存结果的影响。
我们对我院 1990 年 3 月至 2016 年 6 月期间的 I 期或 II 期子宫癌肉瘤患者进行了回顾性队列研究。所有病理学均由妇科病理学家进行了回顾和确认。数据从电子病历中提取。使用描述性和比较性统计数据比较临床病理特征。进行单变量和多变量分析以评估生存结果。
共确定了 140 名患者。中位年龄为 67 岁（范围：36-91 岁）。中位随访时间为 39.1 个月（2.9-297.4）。大多数患者为 IA 期（67%），IB 期（21%）或 II 期（11%）疾病。大多数患者（63%）接受了辅助治疗：单纯阴道近距离放疗（14%）；单纯盆腔外照射（16%）；单纯化疗（n=13，9%）；化疗联合阴道近距离放疗（15%）；化疗联合盆腔外照射（9%）。52 名患者（37%）未接受辅助治疗。中位总生存期（OS）为 48.0 个月（95%CI 32.7-80.9）。在 OS 的多变量分析中，年龄增长（HR 1.05，95%CI 1.03-1.08，p<0.001）、较高的分期（IB 期：HR 1.64，95%CI 0.91-2.95，p=0.10；II 期：HR 3.04，95%CI 1.51-6.13，p=0.002）和横纹肌肉瘤成分的存在（HR 1.66，95%CI 1.02-2.70，p=0.04）与 OS 更差显著相关。
年龄增长、分期和横纹肌肉瘤成分的存在与早期子宫癌肉瘤患者的 OS 更差相关。新的治疗方案应除分期外还应纳入其他因素。
