Racial and Ethnic Disparities in Gynecologic Carcinosarcoma: A Single-Institution Experience

Abstract

We aimed to determine the incidence, treatment regimen, and treatment outcomes (including progression-free survival and overall survival) of gynecologic carcinosarcoma, a rare, aggressive, and understudied gynecologic malignancy. This retrospective review included all patients with gynecologic cancers diagnosed and treated at a single tertiary care comprehensive cancer center between January 2012 and May 2021. A total of 2116 patients were eligible for review, of which 84 cases were identified as carcinosarcoma: 66 were uterine (5.2% of uterine cancers), 17 were ovarian (3.6% of ovarian cancers), 1 was cervical (0.28% of cervical cancers), and 1 was untyped. Of the patients, 76.2% presented advanced-stage disease (stage III/IV) at the time of diagnosis. Minority patients were more likely to present with stage III/IV (p < 0.0001). The majority of patients underwent surgical resection followed by systemic chemotherapy with carboplatin and paclitaxel. The median PFS was 7.5 months. Of the patients, 55% were alive 1 year after diagnosis, and 45% were alive at 5 years. In the studied population, minorities were more likely to present with more advanced disease. The rate of gynecologic carcinosarcomas was consistent with historical reports.

Keywords: ethnic disparity; gynecologic carcinosarcoma; incidence; malignant mixed Mullerian tumor; overall survival; racial disparity.

Figure 1

Graphical depiction of uterine (left, A) and ovarian (right, B) carcinosarcoma by race/ethnicity and stage.

Figure 2

Early- vs. late-stage distribution upon presentation of patients with uterine carcinosarcoma, as stratified by the patients’ race. The bars represent percentages of Asian, Black, Latina, or White patients presenting at certain stages. Data were analyzed with chi-square test. Total number of uterine carcinosarcoma patients in this cohort is 66.