Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma

Abstract

Objective: The aims of this study were to determine the prognostic factors, survival outcomes and response to adjuvant therapy in women with uterine carcinosarcoma treated in a single institution.

Study design: This is a cohort study of women diagnosed with carcinosarcoma and treated at the Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. The medical records of all patients diagnosed with carcinosarcoma between January 1960 and July 2002 were reviewed.

Results: A total of 93 women were identified during this period. The median age was 67 years. The most common presentation was abnormal vaginal bleeding, occurring in 85%, followed by pelvic mass in 45%, and abdominal pain in 38%. At surgery there was extra-uterine spread in 54% of women. The median follow-up was 33 months (range 4-146 months). Adjuvant therapy was not associated with survival advantage. Recurrence was diagnosed in 55 patients (59%) and the overall 5-year survival for all stages was 33%. On multivariate analysis depth of myometrial invasion, stage and pelvic nodes metastasis were associated with poor survival.

Conclusion: The poor outcome for these patients may reflect the aggressive nature of carcinosarcoma and that at the time of presentation more than 50% have extra-uterine disease, which was associated with significant poorer survival. Systemic adjuvant therapy has not been associated with significant improvement in the outcome. More studies are needed to better define the appropriate treatment for this rare cancer.