Stage I uterine carcinosarcoma

Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy

Brandon Luke L. Seagle*, Margaux Kanis, Masha Kocherginsky, Jonathan B Strauss, Shohreh Shahabi

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with survival benefit among women with stage I uterine carcinosarcoma. Methods Women with stage I uterine carcinosarcoma (n = 5614) were identified from the 1998–2013 National Cancer Data Base. Kaplan-Meier survival estimates and Cox proportional-hazards regression models were used to evaluate predictors of overall survival. Effects of these predictors were also estimated using propensity score matched analyses for lymphadenectomy, adjuvant chemotherapy, and radiotherapy. Results 42.0% (2360/5614) of women in the cohort received no adjuvant radiation or chemotherapy. Black race and positive surgical margin status were associated with decreased survival by multivariable Cox regression. Among women with pathologically node-negative disease, the hazard of death increased 5% (4–7%) per each one centimeter increase in tumor size (P = 1.9 × 10− 10). From matched cohort analyses, omitting lymphadenectomy was associated with decreased median (interquartile range) survival: 45.2 (36.4–57.6) versus 73.9 (63.8–91.6) months, hazard ratio (HR) (95% CI) 1.38 (1.20–1.59), P = 9.4 × 10− 6. Hazard of death decreased by 3% (1–5%) for each five lymph nodes removed (P = 0.01). Multiagent chemotherapy and vaginal brachytherapy were associated with decreased hazard of death (HR (95% CI) 0.62 (0.54–0.73), P = 1.1 × 10− 9 and HR (95% CI) 0.83 (0.70–0.97), P = 0.02, respectively). Highest five-year survival was observed after brachytherapy and multiagent chemotherapy (74.1% (68.3–80.3%), P < 2.0 × 10− 16). Conclusion Lymphadenectomy to at least 15–20 removed nodes is associated with increased survival of women with node-negative uterine carcinosarcoma. Adjuvant “cuff and chemo” with vaginal brachytherapy and multiagent chemotherapy is associated with increased survival.

Original languageEnglish (US)
Pages (from-to)71-77
Number of pages7
JournalGynecologic Oncology
Volume145
Issue number1
DOIs
StatePublished - Apr 1 2017

Fingerprint

Carcinosarcoma
Brachytherapy
Lymph Node Excision
Cohort Studies
Drug Therapy
Survival
Propensity Score
Adjuvant Radiotherapy
Kaplan-Meier Estimate
Adjuvant Chemotherapy
Proportional Hazards Models
Neoplasms
Radiotherapy
Lymph Nodes
Databases
Radiation

Keywords

  • Carcinosarcoma
  • Chemotherapy
  • Radiotherapy
  • Uterus

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

@article{a3aa4a4ea2a544e19390cba8ac2047f2,
title = "Stage I uterine carcinosarcoma: Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy",
abstract = "Objective To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with survival benefit among women with stage I uterine carcinosarcoma. Methods Women with stage I uterine carcinosarcoma (n = 5614) were identified from the 1998–2013 National Cancer Data Base. Kaplan-Meier survival estimates and Cox proportional-hazards regression models were used to evaluate predictors of overall survival. Effects of these predictors were also estimated using propensity score matched analyses for lymphadenectomy, adjuvant chemotherapy, and radiotherapy. Results 42.0{\%} (2360/5614) of women in the cohort received no adjuvant radiation or chemotherapy. Black race and positive surgical margin status were associated with decreased survival by multivariable Cox regression. Among women with pathologically node-negative disease, the hazard of death increased 5{\%} (4–7{\%}) per each one centimeter increase in tumor size (P = 1.9 × 10− 10). From matched cohort analyses, omitting lymphadenectomy was associated with decreased median (interquartile range) survival: 45.2 (36.4–57.6) versus 73.9 (63.8–91.6) months, hazard ratio (HR) (95{\%} CI) 1.38 (1.20–1.59), P = 9.4 × 10− 6. Hazard of death decreased by 3{\%} (1–5{\%}) for each five lymph nodes removed (P = 0.01). Multiagent chemotherapy and vaginal brachytherapy were associated with decreased hazard of death (HR (95{\%} CI) 0.62 (0.54–0.73), P = 1.1 × 10− 9 and HR (95{\%} CI) 0.83 (0.70–0.97), P = 0.02, respectively). Highest five-year survival was observed after brachytherapy and multiagent chemotherapy (74.1{\%} (68.3–80.3{\%}), P < 2.0 × 10− 16). Conclusion Lymphadenectomy to at least 15–20 removed nodes is associated with increased survival of women with node-negative uterine carcinosarcoma. Adjuvant “cuff and chemo” with vaginal brachytherapy and multiagent chemotherapy is associated with increased survival.",
keywords = "Carcinosarcoma, Chemotherapy, Radiotherapy, Uterus",
author = "Seagle, {Brandon Luke L.} and Margaux Kanis and Masha Kocherginsky and Strauss, {Jonathan B} and Shohreh Shahabi",
year = "2017",
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doi = "10.1016/j.ygyno.2017.01.010",
language = "English (US)",
volume = "145",
pages = "71--77",
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Stage I uterine carcinosarcoma : Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy. / Seagle, Brandon Luke L.; Kanis, Margaux; Kocherginsky, Masha; Strauss, Jonathan B; Shahabi, Shohreh.

In: Gynecologic Oncology, Vol. 145, No. 1, 01.04.2017, p. 71-77.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stage I uterine carcinosarcoma

T2 - Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy

AU - Seagle, Brandon Luke L.

AU - Kanis, Margaux

AU - Kocherginsky, Masha

AU - Strauss, Jonathan B

AU - Shahabi, Shohreh

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Objective To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with survival benefit among women with stage I uterine carcinosarcoma. Methods Women with stage I uterine carcinosarcoma (n = 5614) were identified from the 1998–2013 National Cancer Data Base. Kaplan-Meier survival estimates and Cox proportional-hazards regression models were used to evaluate predictors of overall survival. Effects of these predictors were also estimated using propensity score matched analyses for lymphadenectomy, adjuvant chemotherapy, and radiotherapy. Results 42.0% (2360/5614) of women in the cohort received no adjuvant radiation or chemotherapy. Black race and positive surgical margin status were associated with decreased survival by multivariable Cox regression. Among women with pathologically node-negative disease, the hazard of death increased 5% (4–7%) per each one centimeter increase in tumor size (P = 1.9 × 10− 10). From matched cohort analyses, omitting lymphadenectomy was associated with decreased median (interquartile range) survival: 45.2 (36.4–57.6) versus 73.9 (63.8–91.6) months, hazard ratio (HR) (95% CI) 1.38 (1.20–1.59), P = 9.4 × 10− 6. Hazard of death decreased by 3% (1–5%) for each five lymph nodes removed (P = 0.01). Multiagent chemotherapy and vaginal brachytherapy were associated with decreased hazard of death (HR (95% CI) 0.62 (0.54–0.73), P = 1.1 × 10− 9 and HR (95% CI) 0.83 (0.70–0.97), P = 0.02, respectively). Highest five-year survival was observed after brachytherapy and multiagent chemotherapy (74.1% (68.3–80.3%), P < 2.0 × 10− 16). Conclusion Lymphadenectomy to at least 15–20 removed nodes is associated with increased survival of women with node-negative uterine carcinosarcoma. Adjuvant “cuff and chemo” with vaginal brachytherapy and multiagent chemotherapy is associated with increased survival.

AB - Objective To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with survival benefit among women with stage I uterine carcinosarcoma. Methods Women with stage I uterine carcinosarcoma (n = 5614) were identified from the 1998–2013 National Cancer Data Base. Kaplan-Meier survival estimates and Cox proportional-hazards regression models were used to evaluate predictors of overall survival. Effects of these predictors were also estimated using propensity score matched analyses for lymphadenectomy, adjuvant chemotherapy, and radiotherapy. Results 42.0% (2360/5614) of women in the cohort received no adjuvant radiation or chemotherapy. Black race and positive surgical margin status were associated with decreased survival by multivariable Cox regression. Among women with pathologically node-negative disease, the hazard of death increased 5% (4–7%) per each one centimeter increase in tumor size (P = 1.9 × 10− 10). From matched cohort analyses, omitting lymphadenectomy was associated with decreased median (interquartile range) survival: 45.2 (36.4–57.6) versus 73.9 (63.8–91.6) months, hazard ratio (HR) (95% CI) 1.38 (1.20–1.59), P = 9.4 × 10− 6. Hazard of death decreased by 3% (1–5%) for each five lymph nodes removed (P = 0.01). Multiagent chemotherapy and vaginal brachytherapy were associated with decreased hazard of death (HR (95% CI) 0.62 (0.54–0.73), P = 1.1 × 10− 9 and HR (95% CI) 0.83 (0.70–0.97), P = 0.02, respectively). Highest five-year survival was observed after brachytherapy and multiagent chemotherapy (74.1% (68.3–80.3%), P < 2.0 × 10− 16). Conclusion Lymphadenectomy to at least 15–20 removed nodes is associated with increased survival of women with node-negative uterine carcinosarcoma. Adjuvant “cuff and chemo” with vaginal brachytherapy and multiagent chemotherapy is associated with increased survival.

KW - Carcinosarcoma

KW - Chemotherapy

KW - Radiotherapy

KW - Uterus

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U2 - 10.1016/j.ygyno.2017.01.010

DO - 10.1016/j.ygyno.2017.01.010

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JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

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