Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India.
Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India.
Indian J Cancer. 2021 Apr-Jun;58(2):179-184. doi: 10.4103/ijc.IJC_57_19.
Uterine carcinosarcoma (UCS) is a rare and aggressive malignancy, and there are no existing standard guidelines for adjuvant therapy. Doublet chemotherapy regimens are most favored in adjuvant setting; however, given the early chances of distant recurrences, does a triple-drug adjuvant chemotherapy improve disease-free survival (DFS), remains to be seen. Our aim of the study is to compare and review different adjuvant regimens used in UCS.
Retrospective chart analysis included 37 optimally staged UCS patients. Each of them had either received paclitaxel plus carboplatin (PC) or paclitaxel, ifosfamide, and cisplatin (TIP). A toxicity analysis was charted as per common terminology criteria for adverse events (CTCAE) 4 criteria. A survival analysis was done by the Kaplan-Meier method, and log-rank test was used for comparison of two variables.
Incidence of UCS was 4.1% and mean age (standard deviation) was 58.73 ± 6.3 (range 42 - 71) years. TIP and PC chemotherapies were given to 22 and 15 patients, respectively. Five-year DFS and overall survival for TIP versus PC were 38.2% versus 35.9% (P = 0.118) and 49% versus 50.3% (P = 0.306), respectively, and for Stage I, II versus Stage III was 78.8% versus 12.7%(P = 0.001) and 92.3% versus 34.2% (P = 0.002), respectively. However, in advanced disease (Stage III), there is a trend toward DFS advantage of triple-drug adjuvant regimen (Hazards ratio (HR) = 0.35, 95% confidence interval (CI) = 0.12-1.07). Grade 3 and 4 toxicities were seen in 54.5% patients of TIP chemotherapy group and in 13.3% patients of the PC chemotherapy (P = 0.012).
Triple-drug adjuvant chemotherapy (TIP) confers no survival advantage over doublet chemotherapy (PC), and in turn, increases the grade 3/4 toxicity in the adjuvant setting of optimally staged UCS patients.
子宫癌肉瘤（UCS）是一种罕见且侵袭性强的恶性肿瘤，目前尚无辅助治疗的标准指南。在辅助治疗中，双联化疗方案最受欢迎；然而，鉴于远处复发的早期可能性，三药辅助化疗是否能改善无病生存（DFS），仍有待观察。本研究旨在比较和回顾 UCS 中使用的不同辅助方案。
回顾性图表分析包括 37 例最佳分期的 UCS 患者。他们中的每一位都接受了紫杉醇加卡铂（PC）或紫杉醇、异环磷酰胺和顺铂（TIP）治疗。根据常见不良事件术语标准 4 级（CTCAE）对毒性进行图表分析。采用 Kaplan-Meier 方法进行生存分析，对数秩检验用于比较两个变量。
UCS 的发病率为 4.1%，平均年龄（标准差）为 58.73±6.3（范围 42-71）岁。TIP 和 PC 化疗分别用于 22 例和 15 例患者。TIP 与 PC 化疗的 5 年 DFS 和总生存率分别为 38.2%和 35.9%（P=0.118）和 49%和 50.3%（P=0.306），而对于 I 期、II 期和 III 期，分别为 78.8%和 12.7%（P=0.001）和 92.3%和 34.2%（P=0.002）。然而，在晚期疾病（III 期）中，三药辅助方案在 DFS 方面有优势（危险比（HR）=0.35，95%置信区间（CI）=0.12-1.07）。TIP 化疗组有 54.5%的患者出现 3/4 级毒性，PC 化疗组有 13.3%的患者出现 3/4 级毒性（P=0.012）。
三药辅助化疗（TIP）并不能在最佳分期的 UCS 患者的辅助治疗中提供生存优势，反而会增加 3/4 级毒性。
