TY - JOUR
T1 - Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years
AU - Matsuo, Koji
AU - Ross, Malcolm S.
AU - Yunokawa, Mayu
AU - Johnson, Marian S.
AU - Machida, Hiroko
AU - Omatsu, Kohei
AU - Klobocista, Merieme M.
AU - Im, Dwight D.
AU - Satoh, Shinya
AU - Baba, Tsukasa
AU - Ikeda, Yuji
AU - Bush, Stephen H.
AU - Hasegawa, Kosei
AU - Blake, Erin A.
AU - Takekuma, Munetaka
AU - Shida, Masako
AU - Nishimura, Masato
AU - Adachi, Sosuke
AU - Pejovic, Tanja
AU - Takeuchi, Satoshi
AU - Yokoyama, Takuhei
AU - Ueda, Yutaka
AU - Iwasaki, Keita
AU - Miyake, Takahito M.
AU - Yanai, Shiori
AU - Nagano, Tadayoshi
AU - Takano, Tadao
AU - Shahzad, Mian MK
AU - Ueland, Frederick R.
AU - Kelley, Joseph L.
AU - Roman, Lynda D.
N1 - Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Adjuvant therapy
KW - Elderly
KW - Oldest old
KW - Surgery
KW - Survival
KW - Uterine carcinosarcoma
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U2 - 10.1016/j.suronc.2019.02.002
DO - 10.1016/j.suronc.2019.02.002
M3 - Article
C2 - 31196490
AN - SCOPUS:85062148654
SN - 0960-7404
VL - 29
SP - 25
EP - 32
JO - Surgical Oncology
JF - Surgical Oncology
ER -