Pattern of care in uterine carcinosarcoma : a retrospective analysis of 20 years

Pielsticker, C. (Cindy) (2015) Pattern of care in uterine carcinosarcoma : a retrospective analysis of 20 years. thesis, Medicine.

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Abstract

Introduction: Uterine carcinosarcoma (UCS) is the deadliest malignancy of the uterine corpus with a five year relative survival of 35%. Since UCS is rare, evidence concerning optimal therapy is sparse. Moreover, it is necessary to assess which clinicopathological factors render certain UCS patients at increased risk for recurrence and death of disease. Aims: The purpose of this study was to evaluate the pattern of care of UCS patients diagnosed in the Netherlands between 1993 and 2012. Furthermore, the relationship of treatments and clinicopathological factors with disease free and overall survival was analyzed. Methods: A retrospective analysis was conducted with data from the Dutch Cancer Registry (NKR) and the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). A total of 1140 patients with UCS who received primary surgery were included in the main analysis. Chi-square testing, the Kaplan-Meier method and Cox proportional hazard models were utilized for statistical analysis. Results: Early stage of disease was observed in 66.4% of the patients. Lymphadenectomy was performed in 21.6% and adjuvant therapy given to 54.6% of the patients. Lymphadenectomy and adjuvant therapy were most frequently offered to patients treated in academic hospitals and in the more recent years. In multivariate analysis, disease free and overall survival was significantly improved with lymphadenectomy, adjuvant radiotherapy, chemotherapy or chemo-radiation and diagnosis between 2008 and 2012. The most beneficial effect on outcome was achieved with either excision of >11 nodes or chemo-radiation. Significantly worse disease free and overall survival was observed with age above 65, higher stage and in case of lymphovascular space invasion. Conclusion: Our results seem to support a more aggressive approach to treatment, although this needs to be looked at with discretion due to the retrospective nature of this analysis. Even with aggressive therapy survival was poor, we therefore recommend intensifying research on the molecular level to identify targets for tailored therapy in patients diagnosed with UCS.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Versluis, drs. M.A.C. and Faculty supervisor: and Nijman, prof. dr. H.W. and Department of Obstetrics and Gynecology and University Medical Center Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:04
Last Modified:	25 Jun 2020 11:04
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2365

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