Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Carcinosarcoma: A Retrospective Case Series

Abstract

Purpose: To review a single-center experience over a 27-year period of managing uterine carcinosarcoma (UCS), focusing on surgical practice, adjuvant therapy and clinical outcome. Material and Methods: This was a retrospective study of women with histologically proven UCS treated at the Department of Obstetrics and Gynecology, University of Tübingen, Germany, between 1983 and 2010. Inpatient and outpatient records were reviewed; follow-up and survival data were ascertained. Results: The study population comprised 18 patients with UCS. Primary surgical treatment consisted of total abdominal hysterectomy in 12 patients (67 %) and laparoscopic total hysterectomy in 4 patients (22 %). Bilateral salpingo-oophorectomy was performed in 94 % of patients (17/18). Lymph nodes were evaluated in 15 patients (83 %). Positive pelvic lymph nodes were present in 2 patients (11 %). A total of 17 patients (94 %) received adjuvant therapy. Disease recurred in 7 (39 %) patients of our study group, with no recurrence noted in the 4 patients who underwent laparoscopic surgical staging. Median disease-free survival (DFS) was 48.7 months (95 % CI: 0.0–157.3) and median overall survival (OS) was 49.9 months (95 % CI: 0.0–108.2). The 5-year survival rate was 40 %. Conclusion: UCS is a rare and aggressive uterine neoplasm with high recurrence rates and metastatic potential. Surgical staging consisting of total hysterectomy with bilateral salpingo-oophorectomy and systematic lymphadenectomy is the most important treatment for patients with UCS. Adjuvant radiation therapy appears to decrease pelvic recurrence, but there is a high incidence of distant recurrence, indicating the need for additional systemic treatment.

Zusammenfassung

Einleitung: Im Folgenden wird die Erfahrung eines Zentrums aus 27 Jahren bezüglich des Managements von uterinen Karzinosarkomen (UKS) mit besonderem Fokus auf operative Techniken, adjuvante Therapie und klinisches Outcome dargestellt. Material und Methoden: Dies ist eine retrospektive Studie von Frauen mit einem histologischen Nachweis eines UKS, die in der Universitätsfrauenklinik Tübingen zwischen den Jahren 1983 und 2010 therapiert wurden. Sowohl der stationäre Aufenthalt als auch die ambulante Betreuung wurden analysiert, die Überlebensdaten wurden exploriert. Ergebnisse: Die Studienpopulation beinhaltete 18 Patientinnen mit UKS. Die operative Primärtherapie beinhaltete entweder eine totale abdominale Hysterektomie bei 12 Patientinnen (67 %), oder eine totale laparoskopische Hysterektomie bei 4 Patientinnen (22 %). Eine systematische Lymphonodektomie wurde bei 15 Patientinnen (83 %) durchgeführt, eine Nodalpositivität ergab sich bei 2 Patientinnen (11 %). In Summe erhielten 17 Frauen (94 %) eine adjuvante Therapie. Ein Rezidiv zeigte sich bei insgesamt 7 Patientinnen (39 %), keine der 4 Patientinnen nach minimalinvasiver operativer Therapie hatte ein Rezidiv. Das mediane krankheitsfreie Überleben betrug 48,7 Monate, das mediane Gesamtüberleben betrug 49,9 Monate. Das 5-Jahres-Überleben betrug 40 %. Zusammenfassung: UKS sind sehr seltene und aggressive uterine Neoplasien mit einem hohen Rezidiv- und Metastasierungsrisiko. Die Therapie beinhaltet als wichtigstes Element das chirurgische Staging bestehend aus totaler Hysterektomie mit beidseitiger Adnexektomie und systematischer Lymphonodektomie. Die adjuvante Radiotherapie senkt die Inzidenz von Beckenrezidiven, allerdings deutet die hohe Rate an Fernmetastasen auf die Vorteile einer systemischen Therapie hin.

Key words

uterine carcinosarcoma - uterine neoplasms - surgical staging - adjuvant therapy

Schlüsselwörter

uterines Karzinosarkom - uterine Neoplasien - chirurgisches Staging - adjuvante Therapie

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