Clinical Outcomes of Uterine Carcinosarcoma: Results of 94 Patients

2015 ◽  
Vol 25 (2) ◽  
pp. 279-287 ◽  
Author(s):  
Zeynep Kestel Gokce ◽  
Taner Turan ◽  
Alper Karalok ◽  
Tolga Tasci ◽  
Isin Ureyen ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Independent Prognostic Factor ◽  
Peritoneal Cytology ◽  
Uterine Carcinosarcoma ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Staging Surgery ◽  
Positive Peritoneal Cytology

ObjectiveWe aimed to determine the clinicopathologic features and identify prognostic factors of patients with uterine carcinosarcoma.Materials and MethodsA total of 94 patients with uterine carcinosarcoma who were diagnosed between January 1993 and October 2013 were included. Staging surgery consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy. Staging is undertaken according to the 2009 International Federation of Gynecology and Obstetrics staging system. Kaplan-Meier survival analysis was used to determine the effects of variables on disease-free survival (DFS) and overall survival (OS).ResultsSeventy-nine patients underwent staging surgery and none of them had residual tumor after surgery. Three-year DFS and 3-year OS were 42.7% and 59.2%, respectively. In the univariate analysis, stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, and extrapelvic metastases were associated with 3-year DFS and stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, adnexal involvement, and extrapelvic metastases were associated with 3-year OS. Seventy-four patients received adjuvant therapy. Adjuvant therapy did not reduce recurrence or improve survival. Any of the chemotherapy regimens was not superior to the others. In the multivariate analysis, only age was an independent prognostic factor for 3-year DFS and no parameter was statistically significant for 3-year OS.ConclusionsAge was an independent prognostic factor for 3-year DFS. Older age was associated with poor survival. Extrauterine spread was associated with survival. The aims of surgery should be both staging and providing tumoral debulking. Prospective randomized trials are needed to better define the necessity and modality of the administered adjuvant therapy.

Analysis of Patients With Stage IIIC Endometrial Cancer

2014 ◽  
Vol 24 (6) ◽  
pp. 1033-1041 ◽  
Author(s):  
Taner Turan ◽  
Isin Ureyen ◽  
Ipek Duzguner ◽  
Enis Ozkaya ◽  
Tolga Tasci ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Univariate Analysis ◽  
Independent Prognostic Factor ◽  
Stage Iiic ◽  
Metastatic Lymph Nodes ◽  
Systematic Lymphadenectomy ◽  
Metastatic Lymph ◽  
Gynecology And Obstetrics

ObjectiveWe aimed to define the factors that are related to recurrence and survival in patients with stage IIIC endometrial carcinoma in this study.Materials and MethodsA total of 147 patients who underwent staging surgery and had a diagnosis of stage IIIC1 to IIIC2 endometrial cancer according to the International Federation of Gynecology and Obstetrics 2009 were included. Patients whose data could not be obtained and patients with a diagnosis of uterine sarcoma and with synchronous tumors were excluded.ResultsMean age of the patients was 58.6 years. Among these patients, 63 had stage IIIC1 and 84 had stage IIIC2 disease. Extrauterine spread was detected in 22% of the patients. Median number of paraaortic (PA) and pelvic lymph nodes removed were 16.5 and 38, respectively. Paraaortic and pelvic nodal involvements were detected in 84 patients and 125 patients, respectively. Radiotherapy was applied more commonly as an adjuvant therapy. Three-year progression-free survival (PFS) and 3-year disease-specific survival (DSS) were 65% and 84%, respectively. Seventy percent of the recurrences were outside the pelvis. Site of metastatic lymph nodes and the number of metastatic PA lymph nodes were associated with 3-year PFS and lymphovascular space invasion; site of metastatic lymph nodes and the presence of recurrence were associated with 3-year DSS in the univariate analysis. Although any surgicopathological factor was not related to 3-year PFS, only the presence of recurrence was an independent prognostic factor for a 3-year DSS in the multivariate analysis (hazard ratio, 0.017; 95% confidence interval, 0.002–0.183).ConclusionsThe number of debulked metastatic lymph nodes and PA involvement were associated with recurrence in the univariate analysis. The presence of recurrence was the only independent prognostic factor detecting survival. Therefore, systematic lymphadenectomy involving PA lymph nodes instead of sampling should be performed in patients with high risk for nodal involvement in endometrial cancer.

Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor: A proposal of new nodal classification

Surgery ◽  
2014 ◽  
Vol 155 (1) ◽  
pp. 74-84 ◽  
Author(s):  
Hyo Jeong Kang ◽  
Soo-Heang Eo ◽  
Song Cheol Kim ◽  
Kwang-Min Park ◽  
Young-Joo Lee ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Lymph Nodes ◽  
Ampulla Of Vater ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph

Stage III Uterine Carcinosarcoma: 2009 International Federation of Gynecology and Obstetrics Staging System and Prognostic Determinants

2011 ◽  
Vol 21 (9) ◽  
pp. 1606-1612 ◽  
Author(s):  
Gunjal Garg ◽  
Michael Kruger ◽  
Carl Christensen ◽  
Gunter Deppe ◽  
Eugene P. Toy
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Involvement ◽  
Disease Spread ◽  
Peritoneal Cytology ◽  
Uterine Carcinosarcoma ◽  
Stage Iiic ◽  
Gynecology And Obstetrics ◽  
Node Involvement ◽  
Positive Peritoneal Cytology

Objectives(1) To determine the significance of positive peritoneal cytology and pelvic versus para-aortic lymph node involvement in uterine carcinosarcoma. (2) To evaluate the impact of isolated retroperitoneal lymph node involvement (IIIC-N) versus retroperitoneal lymph node involvement plus other evidence of extrauterine disease spread (IIIC-N+) on survival in patients with stage IIIC uterine carcinosarcoma.MethodsData were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Statistical analysis used χ2, Kaplan-Meier method, and Cox proportional hazards model.ResultsA total of 690 women were identified. When comparing overall survival between patients with disease spread to uterine serosa and/or adnexa and those with positive peritoneal cytology, there was no significant difference (25.4% vs 15.5%, P = 0.2). However, although the 5-year overall survival was comparable between patients with positive pelvic lymph nodes and those with positive para-aortic lymph nodes (22.1% vs 25.4%, P = 1.0), it was significantly worse in stage IIIC-N(+) compared to stage IIIC-N patients (15.0% vs 33.4%, P < 0.001). Only patient’s age (P < 0.001), race (P = 0.03), stage (P < 0.03), and lymphadenectomy (P < 0.001) were independent predictors of survival after adjusting for other contributing factors. In addition, the results of unadjusted analysis concerning the survival difference between different stage groups were confirmed on multivariate analysis.ConclusionsPositive peritoneal cytology is associated with poor prognosis in uterine carcinosarcoma, comparable to current International Federation of Gynecology and Obstetrics stage IIIA classification of disease. Although there does not seem to be a significant survival difference between patients with positive pelvic versus those with para-aortic lymph nodes, the prognosis seems to be much worse in patients with stage IIIC uterine carcinosarcoma with other evidence of extrauterine disease spread, suggesting the need for more aggressive therapy.

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