Buhachat Rakchai, Wangrangsimakul Kanakarn, Thiangphak Ekasak, Jiamset Ingporn
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Obstet Gynecol Sci. 2025 Jul;68(4):283-292. doi: 10.5468/ogs.24201. Epub 2025 Jun 23.
To investigate 2-year overall survival (OS) after progression in patients with uterine carcinosarcoma (UCS).
This retrospective descriptive cohort study included patients diagnosed with progressive UCS at all stages, who underwent surgical staging with or without adjuvant therapy between January 2002 and December 2022. Clinicopathological characteristics, including recurrence patterns, were assessed using descriptive statistics, Fisher's exact test, and the chi-squared test. Prognostic factors and OS after progression were analyzed using the Cox proportional hazards model and Kaplan-Meier method, respectively.
Fifty-four patients (mean age, 61 years) were eligible for analysis. During primary treatment, 40 patients underwent optimal surgery, 44 received adjuvant chemotherapy with or without radiotherapy, and 43 developed progressive disease within the first 2 years (median progression-free interval: 10.5 months). Overall, 74.07% of patients developed distant or combined metastases. During salvage treatment, 22 patients received chemotherapy, 11 received a combination of chemotherapy and radiotherapy, and five underwent radiotherapy alone. The median follow-up period was 18 months, with a 2-year OS rate of 20% post-progression. Multivariate analysis revealed that leukocytosis at progression was associated with decreased survival (hazard ratio [HR], 5.98; 95% confidence interval [CI], 2.33-15.3; P<0.001). Notably, optimal primary surgery (HR, 0.31; 95% CI, 0.13-0.72; P=0.006) and chemoradiotherapy as salvage treatment (HR, 0.23; 95% CI, 0.08-0.7; P=0.009) significantly improved survival.
Patients with progressive UCS have poor OS. Optimal surgery as primary treatment combined with salvage chemoradiotherapy improves post-progression survival. Leukocytosis during disease progression significantly affects survival outcomes.
研究子宫癌肉瘤（UCS）患者病情进展后的2年总生存率（OS）。
这项回顾性描述性队列研究纳入了所有分期被诊断为病情进展的UCS患者，这些患者在2002年1月至2022年12月期间接受了手术分期，部分患者接受了辅助治疗。使用描述性统计、Fisher精确检验和卡方检验评估包括复发模式在内的临床病理特征。分别使用Cox比例风险模型和Kaplan-Meier方法分析预后因素和病情进展后的总生存率。
54例患者（平均年龄61岁）符合分析条件。在初始治疗期间，40例患者接受了最佳手术，44例接受了辅助化疗（有或无放疗），43例在最初2年内出现病情进展（无进展生存期的中位数：10.5个月）。总体而言，74.07%的患者发生远处转移或合并转移。在挽救治疗期间，22例患者接受了化疗，11例接受了化疗与放疗联合治疗，5例仅接受了放疗。中位随访期为18个月，病情进展后的2年总生存率为20%。多因素分析显示，病情进展时白细胞增多与生存率降低相关（风险比[HR]，5.98；95%置信区间[CI]，2.33 - 15.3；P<0.001）。值得注意的是，最佳初始手术（HR，0.31；95% CI，0.13 - 0.72；P = 0.006）和挽救性放化疗（HR，0.23；95% CI，0.08 - 0.7；P = 0.009）显著提高了生存率。
病情进展的UCS患者总生存率较差。作为初始治疗的最佳手术联合挽救性放化疗可改善病情进展后的生存率。疾病进展期间的白细胞增多显著影响生存结局。
