Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus

BACKGROUND. The purpose of this study was to determine clinicopathologic va riables associated with extrauterine disease, recurrence, and survival in p atients with carcinosarcoma (CS) of the uterus. METHODS. Patients believed to have disease confined to the uterine corpus w ho underwent primary surgical assessment were identified and data retrospec tively reviewed. RESULTS. Occult metastases were found in 38 (61%) of 62 patients. At last f ollowup, 31 (50%) had had recurrence, with an extrapelvic component in 43%, and 53% had died. Depth of myometrial invasion and lymph-vascular space in vasion (LVSI) were associated with extrauterine disease. Five-year survival for patients with disease confined to the corpus (74%) was significantly g reater than for those with more advanced disease (24%, P = 0.0013). Factors associated with recurrence and survival included depth of myometrial invas ion, LVSI, adnexal and serosal involvement, positive cytology, and lymph no de metastases. Of 24 patients with uterine disease only, 11 received no adj uvant therapy, yet 8 (73%) were free of disease at last follow-up. Neither adjuvant radiotherapy nor chemotherapy was identified as an independent pro gnostic variable for recurrence or survival. CONCLUSIONS. More than half of patients with CS clinically confined to the uterine corpus harbor occult metastases in a pattern similar to that found with endometrial carcinoma. Survival is significantly diminished for this g roup. Although the benefit of adjuvant therapy cannot be demonstrated by th is study, a number of early stage patients survive without adjuvant therapy . This argues for extending the International Federation of Gynecology and Obstetrics endometrial carcinoma surgical staging system to include CS, and also for conducting prospective trials to examine the benefits of adjuvant therapy for patients with early stage disease. (C) 2000 American Cancer So ciety.