Koji Matsuo1, Marian S Johnson2, Dwight D Im3, Malcolm S Ross4, Stephen H Bush5, Mayu Yunokawa6, Erin A Blake1,7, Tadao Takano8, Merieme M Klobocista9, Kosei Hasegawa10, Yutaka Ueda11, Masako Shida12, Tsukasa Baba13, Shinya Satoh14, Takuhei Yokoyama15, Hiroko Machida1,12, Yuji Ikeda16, Sosuke Adachi17, Takahito M Miyake18, Keita Iwasaki19, Shiori Yanai20, Satoshi Takeuchi21, Masato Nishimura22, Tadayoshi Nagano23, Munetaka Takekuma24, Mian M K Shahzad5, Tanja Pejovic25, Kohei Omatsu26, Joseph L Kelley3, Frederick R Ueland2, Lynda D Roman1. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky. 3. The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, Maryland. 4. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, Florida. 6. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado. 8. Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan. 9. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York. 10. Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan. 11. Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan. 12. Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan. 13. Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan. 14. Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan. 15. Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan. 16. Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan. 17. Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan. 18. Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan. 19. Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan. 20. Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan. 21. Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan. 22. Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan. 23. Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan. 24. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan. 25. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon. 26. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
Abstract
BACKGROUND AND OBJECTIVES: To examine survival of women with stage IV uterine carcinosarcoma (UCS) who received neoadjuvant chemotherapy followed by hysterectomy. METHODS: This is a nested case-control study within a retrospective cohort of 1192 UCS cases. Women who received neoadjuvant chemotherapy followed by hysterectomy based-surgery for stage IV UCS (n = 26) were compared to those who had primary hysterectomy-based surgery without neoadjuvant chemotherapy for stage IV UCS (n = 120). Progression-free survival (PFS) and cause-specific survival (CSS) were examined. RESULTS: The most common regimen for neoadjuvant chemotherapy was carboplatin/paclitaxel (53.8%). Median number of neoadjuvant chemotherapy cycles was 4. PFS was similar between the neoadjuvant chemotherapy group and the primary surgery group (unadjusted-hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.75-1.89, P = 0.45). Similarly, CSS was comparable between the two groups (unadjusted-HR 1.13, 95%CI 0.68-1.90, P = 0.64). When the types of neoadjuvant chemotherapy regimens were compared, women who received a carboplatin/paclitaxel regimen had better survival outcomes compared to those who received other regimens: PFS, unadjusted-HR 0.38, 95%CI 0.15-0.93, P = 0.027; and CSS, unadjusted-HR 0.21, 95%CI 0.07-0.61, P = 0.002. CONCLUSION: Our study found that there is no statistically significant difference in survival between women with stage IV UCS who are tolerated neoadjuvant chemotherapy and those who undergo primary surgery.
BACKGROUND AND OBJECTIVES: To examine survival of women with stage IV uterine carcinosarcoma (UCS) who received neoadjuvant chemotherapy followed by hysterectomy. METHODS: This is a nested case-control study within a retrospective cohort of 1192 UCS cases. Women who received neoadjuvant chemotherapy followed by hysterectomy based-surgery for stage IV UCS (n = 26) were compared to those who had primary hysterectomy-based surgery without neoadjuvant chemotherapy for stage IV UCS (n = 120). Progression-free survival (PFS) and cause-specific survival (CSS) were examined. RESULTS: The most common regimen for neoadjuvant chemotherapy was carboplatin/paclitaxel (53.8%). Median number of neoadjuvant chemotherapy cycles was 4. PFS was similar between the neoadjuvant chemotherapy group and the primary surgery group (unadjusted-hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.75-1.89, P = 0.45). Similarly, CSS was comparable between the two groups (unadjusted-HR 1.13, 95%CI 0.68-1.90, P = 0.64). When the types of neoadjuvant chemotherapy regimens were compared, women who received a carboplatin/paclitaxel regimen had better survival outcomes compared to those who received other regimens: PFS, unadjusted-HR 0.38, 95%CI 0.15-0.93, P = 0.027; and CSS, unadjusted-HR 0.21, 95%CI 0.07-0.61, P = 0.002. CONCLUSION: Our study found that there is no statistically significant difference in survival between women with stage IV UCS who are tolerated neoadjuvant chemotherapy and those who undergo primary surgery.
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