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Surgical and Oncologic Outcomes in Uterine Carcinosarcoma: A Retrospective Cohort Analysis
Rahul Chatterjee1,2, Alexandra Cocking2, Mohammad Eddama3,4
1The Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, U.K.; rahul.chatterjee@rmh.nhs.uk.
Background/Aim:
Uterine carcinosarcoma (UCS) is a rare but highly aggressive endometrial malignancy with poor prognosis. Optimal management involves a multimodal approach, including surgery followed by adjuvant chemoradiotherapy. Given its rarity, reporting institutional experiences is essential to expand knowledge and improve patient outcomes. This study presents a retrospective analysis of UCS cases managed at a London tertiary centre for Gynaecological Oncology, focusing on perioperative characteristics and survival outcomes.
Patients And Methods:
We conducted a retrospective comparative analysis of case series of 45 patients who underwent treatment for UCS at Guy's & St Thomas' NHS Foundation Trust between March 2018 and December 2020. Perioperative characteristics, staging, and treatment modalities were analysed. Kaplan-Meier survival analysis was performed to evaluate overall survival (OS) and progression-free survival (PFS), comparing patients who received adjuvant chemoradiotherapy to those who did not.
Results:
There was a significant increase in disease stage postoperatively compared to preoperative assessment (p=0.0008). Initially, 30 (68%) and seven (16%) patients were classified as stage I and stage III, respectively. However, final postoperative staging identified 15 (34%) as stage I and 21 (48%) as stage III, highlighting the high rate of upstaging. The mean OS for the cohort was 32.4 months [95% confidence interval (CI)=26.4-38.4]. Kaplan-Meier analysis demonstrated significantly longer OS in patients receiving adjuvant radiotherapy compared to those who did not (mean OS: 39.9 months, 95%CI=30.9-48.8 vs. 26.6 months, 95%CI=19.6-33.6; log-rank p=0.044). Similarly, PFS was significantly improved in patients treated with combined chemoradiotherapy compared to radiotherapy alone (mean PFS: 39.1 months, 95%CI=25.9-52.2 vs. 21.2 months, 95%CI=7.7-34.6; Breslow p=0.02).
Conclusion:
A multimodal approach, including surgery and adjuvant treatment, improves survival in UCS. High upstaging rates highlight the need for better preoperative assessment and vigilant monitoring. Further research is needed to optimise treatment strategies.
