J Alejandro Rauh-Hain1, Kristen D Starbuck1, Larissa A Meyer2, Joel Clemmer1, John O Schorge1, Karen H Lu2, Marcela G Del Carmen3. 1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 2. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. 3. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: mdelcarmen@partners.org.
Abstract
OBJECTIVE: Evaluate rates of chemotherapy and radiotherapy delivery in the treatment of uterine carcinosarcoma, and compare clinical outcomes of treated and untreated patients. METHODS: The National Cancer Database was queried to identify patients diagnosed with uterine carcinosarcoma between 2003 and 2011. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. RESULTS: A total of 10,609 patients met study eligibility criteria. Stages I, II, III, and IV disease accounted for 2997 (28.2%), 642 (6.1%), 2037 (19.2%), and 1316 (12.4%) of the study population, respectively. Most patients (91.0%) underwent definitive surgery, and lymphadenectomy was performed in 68.7% of the patients. Chemotherapy was administered in 2378 (22.4%) patients, radiotherapy to 2196 (20.7%), adjuvant chemo-radiation to 1804 (17.0%), and 4231 (39.9%) of women did not received adjuvant therapy. Utilization of chemotherapy became more frequent over time. Over the entire study period, after adjusting for race, period of diagnosis, facility location, facility type, insurance provider, stage, age, treatment modality, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between treatment modality and survival. The lowest hazard ratio observed was in patients that received chemo-radiation. The strongest quantitative predictor of death was stage at the time of diagnosis. In addition, surgical treatment, lymph node dissection, most recent time-periods, lower comorbidity index, and higher socioeconomic status were associated with improved survival. CONCLUSION: The overall rates of chemotherapy use have increased over time. Adjuvant chemotherapy and chemo-radiation were associated with improved survival.
OBJECTIVE: Evaluate rates of chemotherapy and radiotherapy delivery in the treatment of uterine carcinosarcoma, and compare clinical outcomes of treated and untreated patients. METHODS: The National Cancer Database was queried to identify patients diagnosed with uterine carcinosarcoma between 2003 and 2011. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. RESULTS: A total of 10,609 patients met study eligibility criteria. Stages I, II, III, and IV disease accounted for 2997 (28.2%), 642 (6.1%), 2037 (19.2%), and 1316 (12.4%) of the study population, respectively. Most patients (91.0%) underwent definitive surgery, and lymphadenectomy was performed in 68.7% of the patients. Chemotherapy was administered in 2378 (22.4%) patients, radiotherapy to 2196 (20.7%), adjuvant chemo-radiation to 1804 (17.0%), and 4231 (39.9%) of women did not received adjuvant therapy. Utilization of chemotherapy became more frequent over time. Over the entire study period, after adjusting for race, period of diagnosis, facility location, facility type, insurance provider, stage, age, treatment modality, lymph node dissection, socioeconomic status, and comorbidity index, there was an association between treatment modality and survival. The lowest hazard ratio observed was in patients that received chemo-radiation. The strongest quantitative predictor of death was stage at the time of diagnosis. In addition, surgical treatment, lymph node dissection, most recent time-periods, lower comorbidity index, and higher socioeconomic status were associated with improved survival. CONCLUSION: The overall rates of chemotherapy use have increased over time. Adjuvant chemotherapy and chemo-radiation were associated with improved survival.
Authors: Koji Matsuo; Kohei Omatsu; Malcolm S Ross; Marian S Johnson; Mayu Yunokawa; Merieme M Klobocista; Dwight D Im; Stephen H Bush; Yutaka Ueda; Tadao Takano; Erin A Blake; Kosei Hasegawa; Tsukasa Baba; Masako Shida; Shinya Satoh; Takuhei Yokoyama; Hiroko Machida; Sosuke Adachi; Yuji Ikeda; Keita Iwasaki; Takahito M Miyake; Shiori Yanai; Masato Nishimura; Tadayoshi Nagano; Munetaka Takekuma; Satoshi Takeuchi; Tanja Pejovic; Mian Mk Shahzad; Frederick R Ueland; Joseph L Kelley; Lynda D Roman Journal: Gynecol Oncol Date: 2017-02-16 Impact factor: 5.482
Authors: Koji Matsuo; Malcolm S Ross; Mayu Yunokawa; Marian S Johnson; Hiroko Machida; Kohei Omatsu; Merieme M Klobocista; Dwight D Im; Shinya Satoh; Tsukasa Baba; Yuji Ikeda; Stephen H Bush; Kosei Hasegawa; Erin A Blake; Munetaka Takekuma; Masako Shida; Masato Nishimura; Sosuke Adachi; Tanja Pejovic; Satoshi Takeuchi; Takuhei Yokoyama; Yutaka Ueda; Keita Iwasaki; Takahito M Miyake; Shiori Yanai; Tadayoshi Nagano; Tadao Takano; Mian Mk Shahzad; Frederick R Ueland; Joseph L Kelley; Lynda D Roman Journal: Surg Oncol Date: 2019-02-07 Impact factor: 3.279
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