Cargando…
Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment
BACKGROUND: Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203298/ https://www.ncbi.nlm.nih.gov/pubmed/34140809 http://dx.doi.org/10.2147/CMAR.S309551 |
_version_ | 1783708142659436544 |
---|---|
author | Beckmann, Kerri Selva-Nayagam, Sudarshan Olver, Ian Miller, Caroline Buckley, Elizabeth S Powell, Kate Buranyi-Trevarton, Dianne Gowda, Raghu Roder, David Oehler, Martin K |
author_facet | Beckmann, Kerri Selva-Nayagam, Sudarshan Olver, Ian Miller, Caroline Buckley, Elizabeth S Powell, Kate Buranyi-Trevarton, Dianne Gowda, Raghu Roder, David Oehler, Martin K |
author_sort | Beckmann, Kerri |
collection | PubMed |
description | BACKGROUND: Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit, using multi-institutional clinical registry data from South Australia. METHODS: Data for all consecutive cases of UCS from 1980 to 2019 were extracted from the Clinical Cancer Registry. Clinical and treatment-related factors associated with disease-specific mortality (DSM) and all-cause mortality (ACM) were determined using multivariable Cox proportional hazards regression, with subgroup analyses by stage. RESULTS: Median follow-up for the 140 eligible cases was 21 months. 94% underwent hysterectomy, and 72% had an additional pelvic lymph node dissection (PLND). Furthermore, 16% received adjuvant chemotherapy; 11% adjuvant radiotherapy and 16% multimodal chemoradiotherapy, with an increase in the latter two modalities over time. DSM was reduced among those who underwent PLND (HR: 0.41; 95%CI: 0.23–0.74), adjuvant chemotherapy (HR: 0.39; 95%CI: 0.18–0.84) or multimodality treatment (HR: 0.11; 95%CI: 0.06–0.30) compared with hysterectomy alone for the whole cohort and for late stage disease (FIGO III/IV) but not for earlier stage disease, except for reduced DSM with multimodal therapy. Findings were similar for ACM. CONCLUSION: Our findings indicate better survival among those who received PLND, chemotherapy and multimodal adjuvant therapy, with the latter applying to early and late stage disease. However, cautious interpretation is warranted, due to potential “indication bias” and limited power. Further research into effective treatment modalities, ideally using prospective study designs, is needed. |
format | Online Article Text |
id | pubmed-8203298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-82032982021-06-16 Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment Beckmann, Kerri Selva-Nayagam, Sudarshan Olver, Ian Miller, Caroline Buckley, Elizabeth S Powell, Kate Buranyi-Trevarton, Dianne Gowda, Raghu Roder, David Oehler, Martin K Cancer Manag Res Original Research BACKGROUND: Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit, using multi-institutional clinical registry data from South Australia. METHODS: Data for all consecutive cases of UCS from 1980 to 2019 were extracted from the Clinical Cancer Registry. Clinical and treatment-related factors associated with disease-specific mortality (DSM) and all-cause mortality (ACM) were determined using multivariable Cox proportional hazards regression, with subgroup analyses by stage. RESULTS: Median follow-up for the 140 eligible cases was 21 months. 94% underwent hysterectomy, and 72% had an additional pelvic lymph node dissection (PLND). Furthermore, 16% received adjuvant chemotherapy; 11% adjuvant radiotherapy and 16% multimodal chemoradiotherapy, with an increase in the latter two modalities over time. DSM was reduced among those who underwent PLND (HR: 0.41; 95%CI: 0.23–0.74), adjuvant chemotherapy (HR: 0.39; 95%CI: 0.18–0.84) or multimodality treatment (HR: 0.11; 95%CI: 0.06–0.30) compared with hysterectomy alone for the whole cohort and for late stage disease (FIGO III/IV) but not for earlier stage disease, except for reduced DSM with multimodal therapy. Findings were similar for ACM. CONCLUSION: Our findings indicate better survival among those who received PLND, chemotherapy and multimodal adjuvant therapy, with the latter applying to early and late stage disease. However, cautious interpretation is warranted, due to potential “indication bias” and limited power. Further research into effective treatment modalities, ideally using prospective study designs, is needed. Dove 2021-06-10 /pmc/articles/PMC8203298/ /pubmed/34140809 http://dx.doi.org/10.2147/CMAR.S309551 Text en © 2021 Beckmann et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Beckmann, Kerri Selva-Nayagam, Sudarshan Olver, Ian Miller, Caroline Buckley, Elizabeth S Powell, Kate Buranyi-Trevarton, Dianne Gowda, Raghu Roder, David Oehler, Martin K Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title | Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title_full | Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title_fullStr | Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title_full_unstemmed | Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title_short | Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment |
title_sort | carcinosarcomas of the uterus: prognostic factors and impact of adjuvant treatment |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203298/ https://www.ncbi.nlm.nih.gov/pubmed/34140809 http://dx.doi.org/10.2147/CMAR.S309551 |
work_keys_str_mv | AT beckmannkerri carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT selvanayagamsudarshan carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT olverian carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT millercaroline carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT buckleyelizabeths carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT powellkate carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT buranyitrevartondianne carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT gowdaraghu carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT roderdavid carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment AT oehlermartink carcinosarcomasoftheuterusprognosticfactorsandimpactofadjuvanttreatment |