UTERINE CARCINOSARCOMAS - INCIDENCE AND TRENDS IN MANAGEMENT AND SURVIVAL

Our study's aim was to determine the incidence of uterine sarcomas in New York City (NYC) and evaluate trends in frequency, treatment, and s urvival of carcinosarcomas in two Brooklyn hospitals. Population-based cancer registry data for 1976-1985 were used to calculate the inciden ce of uterine sarcomas in NYC women. Medical records and histology sli des of carcinosarcomas at two central Brooklyn hospitals from 1960 to 1995 were reviewed. The incidence of uterine sarcomas in black and whi te women in NYC was 33.4 and 17.0 per million (P < 0.01). Among 97 wom en with carcinosarcomas diagnosed in 1960-1995, 75% were diagnosed pre operatively, 82% had a hysterectomy, and 45% of those in clinical stag e I were upstaged. Predictors of mortality included the presence of ex trauterine extension, deep myometrial invasion, vascular space invasio n, and gross residual disease, with only the first two being independe nt predictors of survival in a multivariate analysis. Adjunctive thera py shifted from radiation in 1960-1969 to cisplatin-based chemotherapy after 1980. In surgical stage III, survival increased significantly b etween 1960-1979 and 1980-1995, but improvement could not be ascribed to particular therapies. The incidence of uterine sarcomas in black wo men was twice that in white women, Surgical staging including omentect omy is recommended in the management of carcinosarcomas. Modern medica l care may have improved the short-term prognosis of carcinosarcomas. (C) 1997 Academic Press.