ISSN : 2146-3123
E-ISSN : 2146-3131

Predictive and Prognostic Factors in Ovarian and Uterine Carcinosarcomas
İrfan Cicin 1, Tahsin Özatlı 2, Esma Türkmen 1, Türkan Özturk 3, Melike Özçelik 4, Devrim Çabuk 5, Ayşe Gökdurnalı 2, Özlem Balvan 4, Yaşar Yıldız 6, Metin Şeker 7, Nuriye Özdemir 8, Burcu Yapar 9, Özgür Tanrıverdi 10, Yusuf Günaydin 11, Serkan Menekşe 12, Berna Öksüzoğlu 2, Asude Aksoy 13, Bülent Erdoğan 1, M. Bekir Hacıoglu 1, Erkan Arpaci 14, Alper Sevinç 15, Mehmet Atilla Uysal 16, Sinem İliaz 16
1Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
2Department of Medical Oncology, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
3Department of Medical Oncology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
4Department of Medical Oncology, Dr. Lütfi Kırdar Research and Training Hospital, İstanbul, Turkey
5Department of Medical Oncology, Kocaeli University School of Medicine, Kocaeli, Turkey
6Department of Medical Oncology, Atatürk Research and Training Hospital, İzmir, Turkey
7Department of Medical Oncology, Cumhuriyet University School of Medicine, Sivas, Turkey
8Department of Medical Oncology, Ankara Numune Research and Training Hospital, Ankara, Turkey
9Department of Medical Oncology, Pamukkale University School of Medicine, Denizli, Turkey
10Department of Medical Oncology, Muğla University School of Medicine, Muğla, Turkey
11Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
12Department of Medical Oncology, Celal Bayar University School of Medicine, Manisa, Turkey
13Department of Medical Oncology, İnönü University School of Medicine, Malatya, Turkey
14Department of Medical Oncology, Sakarya Research and Training Hospital, Sakarya, Turkey
15Department of Medical Oncology, Gaziantep University School of Medicine, Gaziantep, Turkey
16Department of Pulmonology, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, İstanbul, Turkey
DOI : 10.5152/balkanmedj.2016.151268
Pages : 517-524

Abstract

Background: Prognostic factors and the standard treatment approach for gynaecological carcinosarcomas have not yet been clearly defined. Although carcinosarcomas are more aggressive than pure epithelial tumours, they are treated similarly. Serous/clear cell and endometrioid components may be predictive factors for the efficacy of adjuvant chemotherapy (CT) or radiotherapy (RT) or RT in patients with uterine and ovarian carcinosarcomas. Heterologous carcinosarcomas may benefit more from adjuvant CT.

Aims: We aimed to define the prognostic and predictive factors associated with treatment options in ovarian (OCS) and uterine carcinosarcoma (UCS).

Study Design: Retrospective cross-sectional study

Methods: We retrospectively reviewed the medical records of patients with ovarian and uterine carcinosarcoma from 2000 to 2013, and 127 women were included in this study (24 ovarian and 103 uterine). Patients admitted to seventeen oncology centres in Turkey between 2000 and December 2013 with a histologically proven diagnosis of uterine carcinosarcoma with FIGO 2009 stage I-III and patients with sufficient data obtained from well-kept medical records were included in this study. Stage IV tumours were excluded. The patient records were retrospectively reviewed. Data from 104 patients were evaluated for this study.

Results: Age (≥70 years) was a poor prognostic factor for UCS (p=0.036). Pelvic±para aortic lymph node dissection did not affect overall survival (OS) (p=0.35). Macroscopic residual disease was related with OS (p<0.01). The median OS was significantly longer in stage I-II patients than stage III patients (p=0.03). Adjuvant treatment improved OS (p=0.013). Adjuvant radiotherapy tended to increase the median OS (p=0.075). However, this tendency was observed in UCS (p=0.08) rather than OCS (p=0.6).Adjuvant chemotherapy had no effect on OS (p=0.15).Adjuvant radiotherapy significantly prolonged the median OS in patients with endometrioid component (p=0.034). A serous/clear cell component was a negative prognostic factor (p=0.035). Patients with serous/clear cell histology for whom adjuvant chemotherapy was applied had significantly longer OS (p=0.019), and there was no beneficial effect of adjuvant radiotherapy (p=0.4). Adjuvant chemotherapy was effective in heterologous tumours (p=0.026). In multivariate analysis, the stage and chemotherapy were prognostic factors for all patients. Age was an independent prognostic factor for UCS. However, serous/clear cell histology and radiotherapy tended to be significant prognostic factors.

Conclusion: The primary location, the histological type of sarcomatous and the epithelial component may be predictive factors for the efficacy of chemotherapy or radiotherapy in UCS and OCS.

Keywords : Carcinosarcoma, ovary, uterine, predictive factors, prognostic factors
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