Background: Uterine carcinosarcoma (UC) is a rare and aggressive subtype of endometrial carcinoma associated with late stage at time of diagnosis and poor prognosis. Due to its low incidence, the optimal management of these patients following primary surgical treatment is uncertain.
Aim: To review the characteristics, treatment and outcomes of a cohort of UC cases from a tertiary gynaecology oncology unit in Melbourne, Australia.
Methods: 92 cases of UC were identified from the pathology records of four gynaeoncologists between 1994 and 2016 inclusive. Patient characteristics, histopathology reports, type(s) of adjuvant therapy, development of recurrence and survival status were extracted from patient records. Staging was determined based on histopathology reports using the contemporaneous International Federation of Gynaecology and Obstetrics (FIGO) staging system at the time of diagnosis.
Results: 33 (36%) patients were diagnosed with Stage I,15 (16%) with Stage II, 27 (29%) with Stage III and 17 (18%) with Stage IV disease. There was an overall recurrence rate of 14% and overall death rate of 49%. When compared by stage, there were no significant differences in recurrence rates, but increasing stage was associated with poorer survival and shorter intervals from diagnosis to death. When compared by types of adjuvant therapy, women who had received radiotherapy alone demonstrating the highest rates of recurrence (63%), compared to chemotherapy alone (4%) or multimodal adjuvant treatment (21%). However, this did not translate to significant differences in survival outcomes. Finally, univariate and multivariate analyses were performed to evaluate the association between various patient, disease and treatment factors with respect to survival. Age at diagnosis and stage of disease were both significant predictors of survival odds, with stage IV UC conferring the highest odds of death when compared to stage I disease (OR 12.5, 95% CI 2-79.2), and women who were older at the time of diagnosis demonstrating a small but significant increase in odds ratio for death (OR 1.06, 95% CI 1.005-1.12). No significant associations between type of adjuvant therapy and death or recurrence and death following both univariate and multivariate analyses were established.
Conclusion: In this relatively large homogenous cohort of UC cases, significant predictors for survival included age at the time of diagnosis and stage of disease. Survival was not influenced by adjuvant treatment modality or presence of recurrence. Further studies are warranted to ascertain the optimal treatment regimen to benefit this specific group of patients.