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. 2019 Jun:29:25-32.
doi: 10.1016/j.suronc.2019.02.002. Epub 2019 Feb 7.

Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years

Koji Matsuo  1 , Malcolm S Ross  2 , Mayu Yunokawa  3 , Marian S Johnson  4 , Hiroko Machida  5 , Kohei Omatsu  6 , Merieme M Klobocista  7 , Dwight D Im  8 , Shinya Satoh  9 , Tsukasa Baba  10 , Yuji Ikeda  11 , Stephen H Bush  12 , Kosei Hasegawa  13 , Erin A Blake  14 , Munetaka Takekuma  15 , Masako Shida  16 , Masato Nishimura  17 , Sosuke Adachi  18 , Tanja Pejovic  19 , Satoshi Takeuchi  20 , Takuhei Yokoyama  21 , Yutaka Ueda  22 , Keita Iwasaki  23 , Takahito M Miyake  24 , Shiori Yanai  25 , Tadayoshi Nagano  26 , Tadao Takano  27 , Mian Mk Shahzad  12 , Frederick R Ueland  4 , Joseph L Kelley  2 , Lynda D Roman  5
Affiliations

Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years

Koji Matsuo et al. Surg Oncol. 2019 Jun.

Abstract

Objective: To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years.

Methods: This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I-IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 (n = 82 [9.1%]), aged 60-79, (n = 526 [58.1%]), and aged <60 (n = 298 [32.9%]).

Results: Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group (P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60-79 group (HR 0.97, 95%CI 0.51-1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60-79 group (HR 1.62, 95%CI 1.09-2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy.

Conclusion: Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group.

Keywords: Adjuvant therapy; Elderly; Oldest old; Surgery; Survival; Uterine carcinosarcoma.

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Figures

Fig. 1.
Fig. 1.. Survival curves based on lymphadenectomy use.
Log-rank test for P-values. Progression-free survival is shown based on age groups: A) aged ≥80, B) aged 60–79, and C) aged < 60 for pelvic lymphadenectomy. Abbreviation: LND, pelvic lymphadenectomy.
See this image and copyright information in PMC

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