Abstract
Purpose
The aim of this study was to compare the clinical characteristics and outcomes of the cases with uterine high-grade endometrioid adenocarcinoma (HGEAC) and uterine carcinosarcoma (UCS).
Methods
A total of 141 patients were included in this study. Of them, 61 cases had uterine HGEAC (group 1) and 80 had UCS (group 2). Both groups were compared in terms of clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival. The Kaplan–Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors.
Results
There were no statistically significant differences between the groups with regard to age, nulliparity, menopausal status, and the main initial symptom. Both groups were similar in terms of stage, depth of myometrial invasion, and lymph node metastasis. Lymphadenectomy was performed in 74% and 91% of the cases in group 1 and group 2, respectively (p < 0.001). LVSI was found to be more frequent in group 1 (p = 0.032); however, in group 2, positive cytology was more common (p = 0.008). Chemotherapy was the main adjuvant therapy for UCS, while radiotherapy was the main adjuvant therapy for HGEAC. There was no difference between the groups in terms of disease-free survival (DFS); however, overall survival (OS) was found to be longer in group 1 (p = 0.029). Histopathologic type and LVSI were determined as independent predictive factors for OS.
Conclusion
UCSs are clinically more aggressive than HGEAC and should be considered as a separate group of tumors.
Similar content being viewed by others
References
Harano K, Hirakawa A, Yunokawa M, Nakamura T, Satoh T, Nishikawa T, et al. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese gynecologic oncology group. Int J Clin Oncol. 2016;21(1):168–76.
Berton-Rigaud D, Devouassoux-Shisheboran M, Ledermann JA, Leitao MM, Powell MA, Poveda A, et al. Gynecologic cancer inter group (GCIG) consensus review for uterine and ovarian carcinosarcoma. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S55–60.
Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: a review of the literature. Gynecol Oncol. 2015;137(3):581–8.
Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 2008;112(1):64–70.
Bland AE, Stone R, Heuser C, Shu J, Jazaeri A, Shutter J, et al. A clinical and biological comparison between malignant mixed Müllerian tumors and grade 3 endometrioid endometrial carcinomas. Int J Gynecol Cancer. 2009;19(2):261–5.
Zhu J, Wen H, Bi R, Perrone T. Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study. J Gynecol Oncol. 2016;27(2):e18.
Gungorduk K, Ozdemir A, Ertas IE, Gokcu M, Telli E, Oge T, et al. Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas. Cancer Res Treat. 2015;47(2):282–9.
Felix AS, Stone RA, Bowser R, Chivukula M, Edwards RP, Weissfeld JL, et al. Comparison of survival outcomes between patients with malignant mixed Mullerian tumors and high-grade endometrioid, clear cell, and papillary serous endometrial cancers. Int J Gynecol Cancer. 2011;21(5):877–84.
Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol. 2008;111(1):82–8.
Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Gl Jacomen. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol. 2005;98(2):274–80.
George E, Lillemoe TJ, Twiggs LB, Perrone T. Malignant mixed Müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 1995;14(1):39–44.
Desai NB, Kollmeier MA, Makker V, Levine DA, Abu-Rustum NR, Alektiar KM. Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma. Gynecol Oncol. 2014;135(1):49–53.
Zhang C, Hu W, Jia N, Li Q, Hua K, Tao X, Wang L, Feng W. Uterine carcinosarcoma and high-risk endometrial carcinomas: a clinicopathological comparison. Int J Gynecol Cancer. 2015;25(4):629–36.
Cantrell LA, Havrilesky L, Moore DT, O’Malley D, Liotta M, Secord AA, Nagel CI, Cohn DE, Fader AN, Wallace AH, Rose P, Gehrig PA. A multi-institutional cohort study of adjuvant therapy in stage I–II uterine carcinosarcoma. Gynecol Oncol. 2012;127(1):22–6.
Sorbe B, Paulsson G, Andersson S, Steineck G. A population-based series of uterine carcinosarcomas with long-term follow-up. Acta Oncol. 2013;52(4):759–66.
Galaal K, Al Moundhri M, Bryant A, Lopes AD, Lawrie TA. Adjuvant chemotherapy for advanced endometrial cancer. Cochrane Database Syst Rev. 2014;10:10. https://doi.org/10.1002/14651858.cd010681.pub2.
Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol. 2015;94(1):98–104.
Lorusso D, Martinelli F, Mancini M, Sarno I, Ditto A, Raspagliesi F. Carboplatin–paclitaxel versus cisplatin–ifosfamide in the treatment of uterine carcinosarcoma: a retrospective cohort study. Int J Gynecol Cancer. 2014;24(7):1256–61.
Garg G, Shah JP, Kumar S, Bryant CS, Munkarah A, Morris RT. Ovarian and uterine carcinosarcomas: a comparative analysis of prognostic variables and survival outcomes. Int J Gynecol Cancer. 2010;20(5):888–94.
Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Ann Oncol. 2016;27(7):1257–66.
Matsuo K, Takazawa Y, Ross MS, Elishaev E, Yunokawa M, Sheridan TB, et al. Characterizing sarcoma dominance pattern in uterine carcinosarcoma: homologous versus heterologous element. Surg Oncol. 2018;27(3):433–40.
Acknowledgements
We thank Prof. Dr. Gülşah Seydaoğlu for the statistical analysis of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kucukgoz Gulec, U., Paydas, S., Gumurdulu, D. et al. Are Uterine Grade 3 Endometrioid Adenocarcinoma and Carcinosarcoma Really Clinically Similar?. Indian J Gynecol Oncolog 17, 48 (2019). https://doi.org/10.1007/s40944-019-0296-z
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s40944-019-0296-z