TY - JOUR
T1 - Characterizing sarcoma dominance pattern in uterine carcinosarcoma
T2 - Homologous versus heterologous element
AU - Matsuo, Koji
AU - Takazawa, Yutaka
AU - Ross, Malcolm S.
AU - Elishaev, Esther
AU - Yunokawa, Mayu
AU - Sheridan, Todd B.
AU - Bush, Stephen H.
AU - Klobocista, Merieme M.
AU - Blake, Erin A.
AU - Takano, Tadao
AU - Baba, Tsukasa
AU - Satoh, Shinya
AU - Shida, Masako
AU - Ikeda, Yuji
AU - Adachi, Sosuke
AU - Yokoyama, Takuhei
AU - Takekuma, Munetaka
AU - Yanai, Shiori
AU - Takeuchi, Satoshi
AU - Nishimura, Masato
AU - Iwasaki, Keita
AU - Johnson, Marian S.
AU - Yoshida, Masayuki
AU - Hakam, Ardeshir
AU - Machida, Hiroko
AU - Mhawech-Fauceglia, Paulette
AU - Ueda, Yutaka
AU - Yoshino, Kiyoshi
AU - Kajiwara, Hiroshi
AU - Hasegawa, Kosei
AU - Yasuda, Masanori
AU - Miyake, Takahito M.
AU - Moriya, Takuya
AU - Yuba, Yoshiaki
AU - Morgan, Terry
AU - Fukagawa, Tomoyuki
AU - Pejovic, Tanja
AU - Nagano, Tadayoshi
AU - Sasaki, Takeshi
AU - Richmond, Abby M.
AU - Post, Miriam D.
AU - Shahzad, Mian M.K.
AU - Im, Dwight D.
AU - Yoshida, Hiroshi
AU - Omatsu, Kohei
AU - Ueland, Frederick R.
AU - Kelley, Joseph L.
AU - Karabakhtsian, Rouzan G.
AU - Roman, Lynda D.
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/9
Y1 - 2018/9
N2 - Objective: To examine significance of sarcoma dominance (SD) patterns in uterine carcinosarcoma (UCS). Methods: This is a secondary analysis of multicenter retrospective study examining women with stages I-IV UCS who underwent primary surgery. SD was defined as >50% of sarcoma component in uterine tumor. SD patterns were grouped as homologous sarcoma without SD (homo/non-dominance, n = 351), heterologous sarcoma without SD (hetero/non-dominance, n = 174), homologous sarcoma with SD (homo/dominance, n = 175), and heterologous sarcoma with SD (hetero/dominance, n = 189), and correlated to tumor characteristics and survival. Results: SD patterns were significantly associated with age, body habitus, carcinoma type, tumor size, depth of myometrial invasion, and nodal metastasis (all, P < 0.05). On univariate analysis, SD was associated with decreased progression-free survival (PFS) and cause-specific survival (CSS) in homologous cases (both, P < 0.05) but not in heterologous cases. On multivariate models, both homologous and heterologous SD patterns remained independent prognostic factors for decreased PFS (adjusted-hazard ratio [HR] ranges: homo/dominance 1.35–1.69, and hetero/dominance 1.47–1.64) and CSS (adjusted-HR ranges: 1.52–1.84 and 1.66–1.81, respectively) compared to homo/non-dominance (all, P < 0.05). Among stage I-III disease, when tumors had SD, adding radiotherapy to chemotherapy was significantly associated with improved PFS (adjusted-HR: homo/dominance 0.49, and hetero/dominance 0.45) and CSS (0.36 and 0.31, respectively) compared to chemotherapy alone (all, P < 0.05); contrary, this association was not observed with absence of SD (all, P > 0.05). Conclusion: In UCS, SD impacts survival in homologous but not in heterologous type. Regardless of sarcoma types, SD was associated with decreased survival in UCS; adding radiotherapy to chemotherapy may be an effective postoperative strategy.
AB - Objective: To examine significance of sarcoma dominance (SD) patterns in uterine carcinosarcoma (UCS). Methods: This is a secondary analysis of multicenter retrospective study examining women with stages I-IV UCS who underwent primary surgery. SD was defined as >50% of sarcoma component in uterine tumor. SD patterns were grouped as homologous sarcoma without SD (homo/non-dominance, n = 351), heterologous sarcoma without SD (hetero/non-dominance, n = 174), homologous sarcoma with SD (homo/dominance, n = 175), and heterologous sarcoma with SD (hetero/dominance, n = 189), and correlated to tumor characteristics and survival. Results: SD patterns were significantly associated with age, body habitus, carcinoma type, tumor size, depth of myometrial invasion, and nodal metastasis (all, P < 0.05). On univariate analysis, SD was associated with decreased progression-free survival (PFS) and cause-specific survival (CSS) in homologous cases (both, P < 0.05) but not in heterologous cases. On multivariate models, both homologous and heterologous SD patterns remained independent prognostic factors for decreased PFS (adjusted-hazard ratio [HR] ranges: homo/dominance 1.35–1.69, and hetero/dominance 1.47–1.64) and CSS (adjusted-HR ranges: 1.52–1.84 and 1.66–1.81, respectively) compared to homo/non-dominance (all, P < 0.05). Among stage I-III disease, when tumors had SD, adding radiotherapy to chemotherapy was significantly associated with improved PFS (adjusted-HR: homo/dominance 0.49, and hetero/dominance 0.45) and CSS (0.36 and 0.31, respectively) compared to chemotherapy alone (all, P < 0.05); contrary, this association was not observed with absence of SD (all, P > 0.05). Conclusion: In UCS, SD impacts survival in homologous but not in heterologous type. Regardless of sarcoma types, SD was associated with decreased survival in UCS; adding radiotherapy to chemotherapy may be an effective postoperative strategy.
KW - Heterologous
KW - Homologous
KW - Sarcoma dominance
KW - Survival
KW - Uterine carcinosarcoma
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U2 - 10.1016/j.suronc.2018.05.017
DO - 10.1016/j.suronc.2018.05.017
M3 - Article
C2 - 30217299
AN - SCOPUS:85049321797
SN - 0960-7404
VL - 27
SP - 433
EP - 440
JO - Surgical Oncology
JF - Surgical Oncology
IS - 3
ER -