Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years. (June 2019)

• Record Type: Journal Article
• Authors: Matsuo, Koji; Ross, Malcolm S.; Yunokawa, Mayu; Johnson, Marian S.; Machida, Hiroko; Omatsu, Kohei; Klobocista, Merieme M.; Im, Dwight D.; Satoh, Shinya; Baba, Tsukasa; Ikeda, Yuji; Bush, Stephen H.; Hasegawa, Kosei; Blake, Erin A.; Takekuma, Munetaka; Shida, Masako; Nishimura, Masato; Adachi, Sosuke; Pejovic, Tanja; Takeuchi, Satoshi; Yokoyama, Takuhei; Ueda, Yutaka; Iwasaki, Keita; Miyake, Takahito M.; Yanai, Shiori; Nagano, Tadayoshi; Takano, Tadao; Shahzad, Mian MK.; Ueland, Frederick R.; Kelley, Joseph L.; Roman, Lynda D.;
• Is Part Of: Surgical oncology. Volume 29(2019)
• Page Start: 25
• Page End: 32
• Publication Date: 2019-06
• Subjects: Uterine carcinosarcoma -- Oldest old -- Elderly -- Surgery -- Adjuvant therapy -- Survival; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2019.02.002
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Objective: To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years. Methods: This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I–IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 ( n = 82 [9.1%]), aged 60–79, ( n = 526 [58.1%]), and aged <60 ( n = 298 [32.9%]). Results: Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group ( P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22–0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60–79 group (HR 0.97, 95%CI 0.51–1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60–79 group (HR 1.62, 95%CI 1.09–2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy. Conclusion: Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group. Highlights: Women aged ≥80 account for ∼10% of uterine carcinosarcoma. Tumors of women aged ≥80 exhibit high-grade carcinoma and heterologous sarcoma. Women aged ≥80 are likely to undergo simple hysterectomy without lymphadenectomy. Women aged ≥80 are less likely to receive postop chemotherapy/radiotherapy. Postop therapy but not lymphadenectomy may improve survival in women aged ≥80.