Cucinella Giuseppe, Zammarrelli William A, Nasioudis Dimitrios, Gabrilovich Sofia, Capasso Ilaria, Berretta Roberto, Scollo Paolo, Raspagliesi Francesco, Baiocchi Glauco, Barresi Giuseppe, Pecorino Basilio, Bogani Giorgio, Kurnit Katherine C, De Brot Louise, Lembo Antonio, Maryam Shahi, Fought Angela J, McGree Michaela E, Chiantera Vito, Bosquet Jesus Gonzalez, Fanfani Francesco, Scambia Giovanni, Abu-Rustum Nadeem R, Mariani Andrea, Giuntoli Robert, Glaser Gretchen, Leitao Mario M
Mayo Clinic, Department of Obstetrics and Gynecology, Rochester, MN, USA; University of Palermo, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), Palermo, Italy.
Memorial Sloan Kettering Cancer Center, Department of Surgery, Gynecology Service, New York, NY, USA.
Int J Gynecol Cancer. 2025 Jun 16:101971. doi: 10.1016/j.ijgc.2025.101971.
Uterine carcinosarcoma without myoinvasion, limited to the endometrial lining/polyp or with no residual uterine disease at the time of hysterectomy, is extremely uncommon, with unknown oncologic outcomes. Thus, this study aimed to evaluate the long-term outcomes of patients with carcinosarcoma without myoinvasion.
Patients with International Federation of Gynecology and Obstetrics 2009 stage IA carcinosarcoma without myoinvasion who underwent surgery from December 1998 to January 2023 were identified from 11 centers worldwide. Patients were classified by tumor status (limited to the endometrium, limited to polyp, no residual disease in the hysterectomy specimen) and by type of adjuvant therapy (chemotherapy vs no chemotherapy). Survival analysis follow-up was limited to the first 5 years after surgery.
Of 97 patients included, 28 (28.9%) had disease confined to a polyp, 55 (56.7%) to the endometrium, and 14 (14.4%) had no residual disease in the hysterectomy specimen. Patients received observation only (n=16, 16.5%), vaginal brachytherapy alone (n=14, 14.4%), external beam radiation therapy ± vaginal brachytherapy (n=5, 5.2%), chemotherapy ± vaginal brachytherapy (n=51, 52.6%), and chemotherapy and external beam radiation therapy ± vaginal brachytherapy (n=7, 7.2%), whereas adjuvant therapy was unknown in 4 patients (4.1%). A total of 29 patients (29.9%) recurred, mostly with a distant pattern of relapse. The 5-year recurrence-free survival was 63.5% (95% CI 53.4% to 75.4%) and the overall survival was 72.0% (95% CI 62.6% to 82.9%). The median follow-up for patients without recurrence was 56.9 months (interquartile range; 21.8-72.9). No significant differences were observed in recurrence-free survival and overall survival based on status of the tumor (p=.99 and p=.43, respectively). The difference in recurrence-free survival and overall survival was not statistically significant based on the receipt of chemotherapy (p=.08 and p=.07, respectively).
Patients with carcinosarcoma without myoinvasion have a poor prognosis, with a high recurrence rate with distant pattern. The use of chemotherapy did not achieve statistical significance but may be limited by our small series.
子宫癌肉瘤无肌层浸润，局限于子宫内膜/息肉或子宫切除时无残留子宫疾病，极为罕见，肿瘤学结局未知。因此，本研究旨在评估无肌层浸润的癌肉瘤患者的长期结局。
从全球11个中心识别出1998年12月至2023年1月期间接受手术的国际妇产科联盟2009年IA期无肌层浸润的癌肉瘤患者。患者按肿瘤状态（局限于子宫内膜、局限于息肉、子宫切除标本无残留疾病）和辅助治疗类型（化疗与未化疗）分类。生存分析随访限于术后前5年。
97例纳入患者中，28例（占28.9%）疾病局限于息肉，55例（占56.7%）局限于子宫内膜，14例（占14.4%）子宫切除标本无残留疾病。患者仅接受观察（16例，占16.5%）、仅接受阴道近距离放疗（14例，占14.4%）、外照射放疗±阴道近距离放疗（5例，占5.2%）、化疗±阴道近距离放疗（51例，占52.6%）以及化疗加外照射放疗±阴道近距离放疗（7例，占7.2%），而4例患者（占4.1%）辅助治疗情况未知。共有29例患者（占29.9%）复发，大多为远处复发模式。5年无复发生存率为63.5%（95%可信区间53.4%至75.4%），总生存率为72.0%（95%可信区间62.6%至82.9%）。无复发患者的中位随访时间为56.9个月（四分位间距；21.8 - 72.9）。基于肿瘤状态，无复发生存率和总生存率未观察到显著差异（分别为p = 0.99和p = 0.43）。基于是否接受化疗，无复发生存率和总生存率的差异无统计学意义（分别为p = 0.08和p = 0.07）。
无肌层浸润的癌肉瘤患者预后较差，远处复发模式的复发率高。化疗的使用未达到统计学意义，但可能受我们小样本系列的限制。
