Vintzileos William, Beer Hannah, Miller David, Lea Jayanthi
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Gynecol Oncol Rep. 2025 Mar 18;58:101722. doi: 10.1016/j.gore.2025.101722. eCollection 2025 Apr.
To evaluate and define the proportion of clinically stage I Uterine Carcinosarcoma (UCS) patients who are upstaged to FIGO stages II-IVB following primary surgery based on final pathology.
We performed a retrospective review of patients diagnosed and treated for UCS at our institution from 2009 to 2023. All patients who underwent primary surgery for UCS and had clinically stage I (uterine-confined) disease were included. Uterine-confined disease was determined based on pre-operative physical exam and imaging. The primary outcome was the proportion of patients who were upstaged after surgery.
Ninety-eight patients underwent primary surgery with a median age of 64 years (IQR 59-68). Twenty-six patients (26.6 %) had suspected extra-uterine disease based on pre-operative evaluation and were excluded. Seventy-two patients (73.4 %) had uterine-confined disease based on pre-operative exam/imaging and underwent staging surgery. Of the 72 patients with clinical stage I disease, 39 patients (54.2 %) were ultimately diagnosed with advanced disease (FIGO Stages II-IVB), while 33 patients (45.8 %) had confirmed early-stage disease on final pathology (FIGO Stages IA or IB). Surgical staging revealed the following: 15.4 % (n = 6) were upstaged to Stage II, 5.1 % (n = 2) to Stage IIIA, 5.1 % (n = 2) to Stage IIIB, 35.9 % (n = 14) to Stage IIIC1, 12.8 % (n = 5) Stage IIIC2, and 25 % (n = 10) to Stage IVB.
More than 50% of patients with pre-operative "uterine-confined" carcinosarcoma were upstaged on final pathology, mostly commonly to Stage III. Our findings underscore the importance of surgical staging since upstaging carries critical prognostic information and implications for adjuvant treatment planning.
根据最终病理结果，评估并确定原发性手术后临床分期为I期的子宫癌肉瘤（UCS）患者中，被上调至国际妇产科联盟（FIGO）II-IVB期的比例。
我们对2009年至2023年在我院诊断和治疗的UCS患者进行了回顾性研究。纳入所有接受UCS原发性手术且临床分期为I期（局限于子宫）疾病的患者。局限于子宫的疾病根据术前体格检查和影像学检查确定。主要结局是术后分期上调的患者比例。
98例患者接受了原发性手术，中位年龄为64岁（四分位间距59-68岁）。26例患者（26.6%）根据术前评估怀疑有子宫外疾病，被排除在外。72例患者（73.4%）根据术前检查/影像学检查诊断为局限于子宫的疾病，并接受了分期手术。在72例临床分期为I期的患者中，39例患者（54.2%）最终被诊断为晚期疾病（FIGO II-IVB期），而33例患者（45.8%）在最终病理检查中确诊为早期疾病（FIGO IA或IB期）。手术分期结果如下：15.4%（n = 6）上调至II期，5.1%（n = 2）上调至IIIA期，5.1%（n = 2）上调至IIIB期，35.9%（n = 14）上调至IIIC1期，12.8%（n = 5）上调至IIIC2期，25%（n = 10）上调至IVB期。
超过50%术前诊断为“局限于子宫”的癌肉瘤患者在最终病理检查中分期上调，最常见的是上调至III期。我们的研究结果强调了手术分期的重要性，因为分期上调携带关键的预后信息，并对辅助治疗计划有影响。
