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Evaluation of chemotherapy and radiotherapy in the adjuvant management of uterine carcinosarcoma: a population-based analysis

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of adjuvant chemotherapy (CT) and radiotherapy (RT) on the survival of uterine carcinosarcoma (UCS) patients.

Methods

We analyzed 3207 patients with uterine carcinosarcoma without distant metastasis after surgery from 2004 to 2015 by utilizing data from the Surveillance, Epidemiology, and End Results database. Generally, cancer-specific survival (CSS) and overall survival (OS) outcomes were analyzed by Kaplan–Meier and Cox proportional hazards regression models. Further subgroup survival analysis was performed for those receiving RT and chemoradiotherapy (CRT).

Results

In general, both univariate and multivariate analyses showed that age, race, marital status, stage, lymph node metastasis, lymphadenectomy (LND), RT, and chemotherapy (CT) were associated with improved CSS and OS (P < 0.05). Further subgroup analysis showed that CRT exhibited a survival advantage over RT or CT alone in different groups. Various RT modalities, including brachytherapy (BT), external radiotherapy (EBRT), and EBRT + BT, were correlated with improved survival for patients aged 60–69 years with stage III–IV disease and lymph node metastasis. Patients with stage I–II disease aged > 70 years seemed to gain survival benefits from brachytherapy (BT) alone. BT with or without external radiotherapy was associated with improved survival for those who did not undergo lymphadenectomy.

Conclusion

For UCS without distant metastasis after surgery, CRT should be considered. Regarding RT, BT alone is efficient in improving survival, especially for patients with stage I–II disease aged > 70 years old. EBRT alone does not show results in survival improvement for patients who did not undergo LND and those with lymph node metastasis. However, considering the limitation of SEER database, further studies with more large sample size and strict study design are needed to confirm it.

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Funding

This study was supported by Grant 2020ZX09201021 from the National Science and Technology Major Project, Grant YXRGZN201902 from the Medical Artificial Intelligence Project of Sun Yat-Sen Memorial Hospital, grants 81572596, 81972471, and 82173232 from the National Natural Science Foundation of China, Grant 2017A030313828 from the Natural Science Foundation of Guangdong Province, grant 201704020131 from the Guangzhou Science and Technology Major Program, Grant 2017B030314026 from the Guangdong Science and Technology Department, Grant 2018007 from the Sun Yat-Sen University Clinical Research 5010 Program, grant SYS-C-201801 from the Sun Yat-Sen Clinical Research Cultivating Program, Grant A2020558 from the Guangdong Medical Science and Technology Program, Grant SYSU-81000-20200311-0001 and SYSU-05160-20200506-0001 from Tencent Charity Foundation.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China

    Lin Ding, Zhuofei Bi, Jialing Wu & Yi-Min Liu

  2. Department of Pharmacy, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China

    Jianhong Zhu & Yunfang Yu

  3. Department of Oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China

    He-Rui Yao

  4. Department of Breast Tumor Cancer Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China

    He-Rui Yao

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  1. Lin Ding
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Contributions

LD data collection and manuscript writing. ZFB data collection and manuscript writing. JLW data collection and manuscript writing. JHZ data analysis. YFY data analysis. YML project development. HRY project development.

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Correspondence to He-Rui Yao or Yi-Min Liu.

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Ding, L., Bi, Z., Wu, J. et al. Evaluation of chemotherapy and radiotherapy in the adjuvant management of uterine carcinosarcoma: a population-based analysis. Arch Gynecol Obstet 307, 891–901 (2023). https://doi.org/10.1007/s00404-022-06589-y

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