Prognostic Factors and Adjuvant Therapy in Uterine Carcinosarcoma

We aimed to investigate clincopathological variables and impact of adjuvant therapy for uterine carcinosarcoma (CS). Cases with uterine CS were retrieved from medical registry (1984 through 2005) of Chang Gung Memorial Hospital. Histological review and ER, PR, c-kit, VEGF-1 and -2 receptor immunohistochemical stain were performed. A total of 45 patients were eligible for analysis (FIGO staging:19 stage I, 2 stage II, 15 stage III, 8 stage IV, and 1 unknown-stage). Cox proportional hazards model was used for multivariate analysis. The median follow-up for survivors was 84 months. 47.6 % of patients with stage I-II and 60.9% with stage III-IV encountered progression/recurrence, of which the sites of failure were known 80% (stage I-II) and 83.3% (stage III-IV) involved distant/local and distant sites. Median time to recurrence/progression was 8 months (0-68 months). 5-year overall survival (OS) and progression-free survival (PFS) rates were 36.5% and 33.6%, respectively for stage I-IV, and 66.4% and 66.9% respectively for stage I. By multivariate analysis, only advanced stage (III-IV vs III, RR: 3.97 [95% CI, 1.07-14.75], p = 0.039) was significant predictor of death, while older age (continuous variable) had marginal significance (P = 0.053). Chemotherapeutic agents used comprised cisplatin, ifosfamide, and doxorubicin. Unfortunately, adjuvant therapy (CT, RT, or CCRT) did not show significant survival benefit. Advanced stage was significantly associated with decreased OS. High proportion of distant metastasis was noted even in CS clinically confined to the uterine corpus. Novel agents are necessary to improve this aggressive disease.