| Objective:Uterine carcinosarcoma,also known as malignant mixed mullerian tumors,is a rare and aggressive variant of endometrial cancer with poor prognosis.There is still no effective therapies.In this study,we retrospectively analyzed the clinicopathological data of patients with uterine carcinosarcoma in Qilu Hospital of Shandong University,aiming to explore the clinicopathological characteristics and prognostic factors of uterine carcinosarcoma,and to provide a reference for better prediction of the clinical outcome and selection of management of uterine carcinosarcoma.Methods:A retrospective analysis of all patients with uterine carcinosarcoma from January 2008 to December 2018 at Qilu Hospital,Shandong University.Collect and organize relevant clinical pathology data,including:name,hospitalization number,age,maternity,major clinical symptoms and signs,preoperative related tumor marker level,surgical method,staging,postoperative pathology,postoperative assisted treatment,etc.Obtain follow-up data on postoperative recurrence,treatment and survival by telephone follow-up.The deadline for follow-up is December 31,2019.Statistical analysis is carried out using SPSS25.0 software and Stata16 software.The test is applied to single-factor analysis,and the Logistic regression model is applied for multi-factor analysis.The cumulative survival rate of each subgroup was calculated by Kaplan-Meier method,and the survival curve was drawn,the difference of survival curve was compared by The Log-rank method,and the variables affecting patient recurrence and survival were analyzed by Cox multi-factor analysis.It is considered that the difference between P<0.05 is statistically significant.Results:47 patients were included in the retrospective study between January 2008 and December 2018.The average age of diagnosis was(55.17 ±12.77)years,and the age range was 15-81 years.The age of onset was mostly concentrated between 50-70 years(47.4%,27/47).There were 17 premenopausal patients(36.2%,17/47)and 30 postmenopausal patients(63.8%,30/47).The most common clinical manifestations are abnormal vaginal bleeding,followed by abnormal vaginal drainage.2 patients were unexpectedly diagnosed during surgery carried out for supposedly benign gynecologic conditions.Preoperative imaging examination(pelvic Doppler ultrasound,pelvic abdominal CT,pelvic abdominal MRI)revealed a mass-occupying lesion with abundant blood flow in the uterine cavity,uterine body or pelvic cavity.Preoperative serum tumor markers may be normal or elevated,but lack specificity.42 of the 47 patients underwent surgery in our hospital,and 5 were operated in other hospitals.FIGO 2009 endometrial cancer surgical staging criteria was used for staging There were 27 patients in FIGOI stage,of which 11 were in FIGOIA stage,16 in FIGOIB stage.4 were in FIGOII stage.12 were in FIGO? stage,of which 3 were in FIGO?A stage,6 were in FIGO?B stage,and 3 cases of FIGO?C stage,including 1 case of FIGOIIIC1 stage and 2 cases of FIGO?C2 stage.There were 4 cases in FIGO stage ?,including 2 cases in FIGO stage IVA and 2 cases in FIGO stage IVB.17 cases had superficial muscle infiltration,30 cases had deep myometrial invasion.17 cases had LVS1 positive;5 cases were positive for lymph nodes,of which 2 cases were positive for only pelvic lymph nodes,lcase only para-aortic lymph nodes was positive,and 2 cases were positive for both pelvic and para-aortic lymph nodes.7 cases had cervical interstitial involvement;12 cases had involvement of parauterine tissue.Most cases consisted of one cancer component and one sarcoma component,and 2 cases had one cancer component and?2 sarcoma components.43 cases were recorded with detailed pathological information of tumor cancer components.The most common histological types were endometrioid carcinoma and serous carcinoma;19 cases were high differentiated,and 24 were moderate-low differentiated and low differentiated.39 cases recorded detailed pathological information of tumor sarcoma components,24 were homologous,15 were heterologous;homologous sarcomas were mostly endometrial stromal sarcoma,and heterologous sarcomas were mostly chondrosarcoma and rhabdomyosarcoma sarcoma.Of the 47 patients,4 had no adjuvant therapy after surgery,37 had chemotherapy alone,4 had concurrent chemoradiotherapy,and 2 had radiotherapy after chemotherapy.Radiotherapy methods are Pelvic external beam radiotherapy.The chemotherapy regimens of patients are diversified.The primary chemotherapy regimens are mainly platinum combined with ifosfamide.The start time of follow-up was the time of surgery and the follow-up deadline was December 31,2019.One of the 47 patients was lost to follow-up,and the missed visit rate was 2.1%.The median follow-up time was 20.3 months(1.5-108.6 months).18 patients reported progress or relapse.The median progression-free survival after surgery was 20.0 months,with a 1-year PFS of 66.0%and a 3-year PFS of 27.7%.Fifteen patients died,with a median OS of 20.2 months(1.5 months to 108.6 months),1-year OS was 70.2%,and 3-year OS was 31.9%.Univariate analysis showed that deep myometrial invasion(P=0.032),histological differentiation of cancer components(P=0.007),histological origin of tumor sarcoma components(P=0.005)and FIGO staging(P=0.00;3)have a correlation between PFS.The age of the patient at diagnosis,whether menopause,surgery,tumor size,LVSI,lymph node involvement,tumor invasion and cervical interstitial condition,parauterine tissue invasion,and postoperative adjuvant treatment methods have no significant correlation with PFS.deep myometrial invasion(P=0.042),the degree of histological differentiation of cancer components(P=0.037),the histological origin of tumor sarcoma components(P=0.043)and FIGO stage(P=0.024)were correlated with OS.The age of the patient at diagnosis,whether menopause,surgery,tumor size,LVSI,lymph node involvement,tumor invasion and cervical interstitial condition,parauterine tissue invasion and postoperative adjuvant treatment methods had no significant correlation with OS.Multivariate analysis of the Cox hazard ratio model found that the degree of histological differentiation of tumor cancer components was an independent prognostic factor related to PFS.Multivariate analysis of the Cox hazard ratio model found that the degree of histological differentiation of tumor cancer components and FIGO stage were independent prognostic factors related to OS.According to the degree of histological differentiation of cancer components and the histological origin of tumor sarcoma components,the cases were divided into three groups.Category 1 includes those whose degree of histological differentiation is low grade and sarcoma component is homologous;category 2 includes whose tumor cancer component is low grade and sarcoma component is heterogeneous,and whose tumor cancer component is high grade and sarcoma component is homologous;category 3 includes whose tumor cancer component is high grade and sarcoma component is heterogeneous.Univariate analysis showed a correlation between this grouping and OS(P=0.039).Multivariate analysis showed that the histological pattern grouping of tumor cancer components and sarcoma components was an independent prognostic factor related to OS.Compared with category 1,patients in categories 2 and 3 had a significantly increased risk of death.Conclusions:1.Uterine carcinosarcoma has a high degree of malignancy and a poor prognosis.The main treatment is surgery combined with radiotherapy and chemotherapy.2.The degree of histological differentiation of tumor cancer components is an independent prognostic factor for disease progression.The degree of histological differentiation of tumor cancer components and FIGO surgery-pathological staging are independent prognostic factors for survival.3.According to the histological model of tumor cancer components and sarcoma components,a subgroup analysis is performed.Those whose cancer components are histologically low-level and sarcoma components are homologous have the best prognosis.Those whose cancer components are high-level and whose sarcoma components are heterologous have the worst prognosis. |
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