Sarcoma Histology, Percentage of Sarcoma, and Tumor Necrosis Are Prognostically Neutral in Uterine Carcinosarcoma
Ian S Hagemann, Dengfeng Cao. Washington University School of Medicine, St. Louis, MO
Background: Uterine carcinosarcoma (malignant mixed Mullerian tumor) is an aggressive variant of endometrial carcinoma which often presents as a necrotic mass, with variable histologies and percentages of sarcoma. The prognostic significance of these factors is uncertain.
Design: We reviewed all uterine carcinosarcomas resected at our institution from 1991 to 2009 for which complete records were available. Reports and slides were reviewed to extract clinicopathologic data including patient demographics, staging, and the histology, relative abundance, and percent necrosis of both carcinoma and sarcoma components. Patient outcomes were retrieved from clinical and public records, with overall survival used as the primary endpoint.
Results: A total of 94 cases were available for inclusion (FIGO stage I, 53 cases; stage III, 27 cases; stage IV, 13 cases), with a mean follow-up interval of 32.7 months. Univariate analysis confirmed the prognostic significance of tumor stage (p=0.0006, log-rank test), of lymphovascular invasion within stage I tumors (p=0.0058), and of depth of myometrial invasion (p=0.0016). Homologous vs. heterologous sarcoma histology was not, overall, prognostically significant, although in patients surviving more than 40 months, homologous differentiation became a favorable indicator. Upon review of intrauterine tumor histology, necrosis was present in the carcinoma component of 49% of cases and, in these cases, averaged 10% in extent. The sarcomatous component showed necrosis in 65% of cases and, in these, averaged 13% in extent. Cases with and without necrosis of either component did not significantly differ in stage (p>0.05, Student's t), nor did they differ in overall survival when compared stage for stage. The percentage of sarcoma ranged from 1% to 99% (mean 54%), but this factor was also not significantly associated with overall survival.
Conclusions: The presence of tumor necrosis, while dramatic, is not prognostically significant in uterine carcinosarcoma. Likewise, the relative percentage of sarcoma and carcinoma does not predict survival. Homologous differentiation, historically considered favorable, appears in this series to be favorable only in long-term survivors.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 196, Wednesday Afternoon