Prognostic parameters in carcinosarcomas of the uterus: A clinico-pathologic study

Background: Carcinosarcomas of the uterus are highly aggressive malignant n eoplasms with early lymphatic and hematogenous spread. The most important p rognostic factor in carcinosarcoma is the event of the tumor at the time of diagnosis. The prognostic impact of other factors such as myometrial invas ion, menopausal age, age, parity and adjuvant therapy is still being discus sed controversially. Materials and Methods: Nineteen patients with histolog ically proven carcinosarcoma were included in the analysis. The patients we re staged according to a modification of the International Federation of Gy necology and Obstetrics (FIGO) staging system for endometrial cancer. For e ach patient, the histological material was reviewed by an experienced patho logist. Carcinosarcoma was defined histologically as any tumor of uterine o rigin composed of carcinomatous and sarcomatous components. Results: The me dian follow-up time was 91 months (25% quartile, 47 months; 75% quartile, 1 45 months). The median overall survival of the 19 patients was 59 months, r esulting in a 5-year overall survival rate of 43%. Three out of the ninetee n (16%) patients demonstrated progressive disease while 6 out of 10 (32%) p atients developed recurrent disease with a median disease free survival of 16 months (range 8-54). Eleven out of nineteen (58%) patients died of the d isease. A univariate model revealed that early tumor stage (stage 1) (p < 0 .023), low myometrial invasion (p < 0.017) and late onset of the menopause (p < 0.050) were significantly associated with a lengthened overall surviva l in patients with carcinosarcoma. Age (p = 0.34), parity (p = 0.16) and ad juvant radiotherapy (p = 0.45) did not influence overall survival of patien ts with carcinosarcoma. Conclusion: Early tumor stage, low myometrial invas ion and late onset of the menopause are associated with a lengthened overal l survival in patients with carcinosarcoma.