Koji Matsuo1, Kohei Omatsu2, Malcolm S Ross3, Marian S Johnson4, Mayu Yunokawa5, Merieme M Klobocista6, Dwight D Im7, Stephen H Bush8, Yutaka Ueda9, Tadao Takano10, Erin A Blake11, Kosei Hasegawa12, Tsukasa Baba13, Masako Shida14, Shinya Satoh15, Takuhei Yokoyama16, Hiroko Machida17, Sosuke Adachi18, Yuji Ikeda19, Keita Iwasaki20, Takahito M Miyake21, Shiori Yanai22, Masato Nishimura23, Tadayoshi Nagano24, Munetaka Takekuma25, Satoshi Takeuchi26, Tanja Pejovic27, Mian Mk Shahzad8, Frederick R Ueland4, Joseph L Kelley3, Lynda D Roman17. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA. Electronic address: koji.matsuo@med.usc.edu. 2. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA. 5. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA. 7. The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA. 8. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA. 9. Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan. 10. Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan. 11. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA. 12. Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan. 13. Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan. 14. Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan. 15. Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan. 16. Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan. 17. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA. 18. Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan. 19. Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan. 20. Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan. 21. Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan. 22. Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan. 23. Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan. 24. Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan. 25. Department of Obstetrics and Gynecology, Shizuoka Cancer Center, Shizuoka, Japan. 26. Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan. 27. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA.
Abstract
BACKGROUND: To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern. METHODS: We examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns. RESULTS: The most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27-0.62, P<0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13-1.58, P=0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P<0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02-0.90; P=0.013) but not in none/single factor (P=0.36). CONCLUSION: Adjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.
BACKGROUND: To examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern. METHODS: We examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns. RESULTS: The most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.83, P=0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27-0.62, P<0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13-1.58, P=0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P<0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02-0.90; P=0.013) but not in none/single factor (P=0.36). CONCLUSION: Adjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.
Authors: Gloria S Huang; Lydia G Chiu; Juliana S Gebb; Marc J Gunter; Paniti Sukumvanich; Gary L Goldberg; Mark H Einstein Journal: Gynecol Oncol Date: 2007-10-23 Impact factor: 5.482
Authors: K Matsuo; Y Takazawa; M S Ross; E Elishaev; I Podzielinski; M Yunokawa; T B Sheridan; S H Bush; M M Klobocista; E A Blake; T Takano; S Matsuzaki; T Baba; S Satoh; M Shida; T Nishikawa; Y Ikeda; S Adachi; T Yokoyama; M Takekuma; K Fujiwara; Y Hazama; D Kadogami; M N Moffitt; S Takeuchi; M Nishimura; K Iwasaki; N Ushioda; M S Johnson; M Yoshida; A Hakam; S W Li; A M Richmond; H Machida; P Mhawech-Fauceglia; Y Ueda; K Yoshino; K Yamaguchi; T Oishi; H Kajiwara; K Hasegawa; M Yasuda; K Kawana; K Suda; T M Miyake; T Moriya; Y Yuba; T Morgan; T Fukagawa; A Wakatsuki; T Sugiyama; T Pejovic; T Nagano; K Shimoya; M Andoh; Y Shiki; T Enomoto; T Sasaki; K Fujiwara; M Mikami; M Shimada; I Konishi; T Kimura; M D Post; M M Shahzad; D D Im; H Yoshida; K Omatsu; F R Ueland; J L Kelley; R G Karabakhtsian; L D Roman Journal: Ann Oncol Date: 2016-04-06 Impact factor: 32.976
Authors: C A Arndt; S S Donaldson; J R Anderson; R J Andrassy; F Laurie; M P Link; R B Raney; H M Maurer; W M Crist Journal: Cancer Date: 2001-06-15 Impact factor: 6.860
Authors: Khadra Galaal; Esther van der Heijden; Keith Godfrey; Raj Naik; Ali Kucukmetin; Andrew Bryant; Nagindra Das; Alberto D Lopes Journal: Cochrane Database Syst Rev Date: 2013-02-28
Authors: Koji Matsuo; Malcolm S Ross; Stephen H Bush; Mayu Yunokawa; Erin A Blake; Tadao Takano; Yutaka Ueda; Tsukasa Baba; Shinya Satoh; Masako Shida; Yuji Ikeda; Sosuke Adachi; Takuhei Yokoyama; Munetaka Takekuma; Satoshi Takeuchi; Masato Nishimura; Keita Iwasaki; Shiori Yanai; Merieme M Klobocista; Marian S Johnson; Hiroko Machida; Kosei Hasegawa; Takahito M Miyake; Tadayoshi Nagano; Tanja Pejovic; Mian Mk Shahzad; Dwight D Im; Kohei Omatsu; Frederick R Ueland; Joseph L Kelley; Lynda D Roman Journal: Gynecol Oncol Date: 2016-12-05 Impact factor: 5.482
Authors: Sarah E Ferguson; Carmen Tornos; Amanda Hummer; Richard R Barakat; Robert A Soslow Journal: Am J Surg Pathol Date: 2007-11 Impact factor: 6.394
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
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: J Gynecol Oncol Date: 2018-11 Impact factor: 4.401
Authors: Lori Cory; Colleen Brensinger; Robert A Burger; Robert L Giuntoli; Mark A Morgan; Nawar Latif; Lilie L Lin; Emily M Ko Journal: Gynecol Oncol Rep Date: 2022-01-17