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Can B, Karataşli V, Çakir İ, Sayhan S, Hansu K, Kuru O. The prognostic significance of the heterologous component in uterine carcinosarcomas. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230517. [PMID: 37729375 PMCID: PMC10508891 DOI: 10.1590/1806-9282.20230517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/25/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. METHODS Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. RESULTS A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. CONCLUSION The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.
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Affiliation(s)
- Behzat Can
- Necip Fazil City Hospital, Department of Gynecological Oncology – Kahramanmaraş, Turkey
| | - Volkan Karataşli
- Şanlıurfa State Hospital, Department of Gynecological Oncology – Sanlıurfa, Turkey
| | - İlker Çakir
- Buca Seyfi Demirsoy Training and Research Hospital, Department of Gynecological Oncology – İzmir, Turkey
| | - Sevil Sayhan
- İzmir Tepecik Training and Research Hospital, Department of Pathology – İzmir, Turkey
| | - Kemal Hansu
- Necip Fazil City Hospital, Department of Obstetrics and Gynecology – Kahramanmaraş, Turkey
| | - Oğuzhan Kuru
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Gynecological Oncology – Istanbul, Turkey
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Tumour markers and their utility in imaging of abdominal and pelvic malignancies. Clin Radiol 2020; 76:99-107. [PMID: 32861463 DOI: 10.1016/j.crad.2020.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 01/15/2023]
Abstract
The utility of tumour biomarkers has increased considerably in the era of personalised medicine and individualised therapy in oncology. Biomarkers may be prognostic or predictive, and only a handful of markers are currently US Food and Drug Administration (FDA)-approved for clinical use. Tumour markers have a wide array of uses such as screening, establishing a differential diagnosis, assessing risk, prognosis, and treatment response, as well as monitoring disease status. Major overlap exists between biomarkers and their associated pathologies; therefore, despite suggestive imaging features, establishing a differential diagnosis may be challenging for the radiologist. We review common biomarkers that are of interest to radiologists such as carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), prostate-specific antigen (PSA), beta human chorionic gonadotropin (β-hCG), carbohydrate antigen 19-9 (CA 19-9), alpha fetoprotein (AFP), and carbohydrate or cancer antigen 125 (CA 125), as well as their associated malignant and non-malignant pathologies. We also present relevant case examples from our practice.
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Abstract
OBJECTIVE To provide a modern overview for radiologists of the unique radiological, pathological, and clinical features of uterine carcinosarcoma (UCS). RESULTS UCS is a unique gynecological malignancy that continues to present diagnostic and therapeutic challenges to the field of oncology. The classification and clinical understanding of this malignancy have evolved in recent years, yielding a modern conceptualization of a neoplastic entity that has been well studied but incompletely understood. As UCS causes a significant proportion of deaths secondary to uterine cancer, developing a familiarity with the imaging and clinical features of this entity is critical. In addition to summarizing the modern understanding of this tumor variant, an overview of the common imaging features of UCS will be presented. The role of radiological staging, imaging findings on presentation and follow-up imaging, and modern treatment paradigms will be discussed. Lastly, the current treatment paradigms and surveillance recommendations for UCS will be summarized. CONCLUSION Knowledge of the modern understanding of uterine carcinosarcoma, including its relevant imaging and clinical features, is critical for radiologists.
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Matsuo K, Ross MS, Yunokawa M, Johnson MS, Machida H, Omatsu K, Klobocista MM, Im DD, Satoh S, Baba T, Ikeda Y, Bush SH, Hasegawa K, Blake EA, Takekuma M, Shida M, Nishimura M, Adachi S, Pejovic T, Takeuchi S, Yokoyama T, Ueda Y, Iwasaki K, Miyake TM, Yanai S, Nagano T, Takano T, Shahzad MM, Ueland FR, Kelley JL, Roman LD. Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years. Surg Oncol 2019; 29:25-32. [PMID: 31196490 PMCID: PMC7523232 DOI: 10.1016/j.suronc.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/19/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years. METHODS This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I-IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 (n = 82 [9.1%]), aged 60-79, (n = 526 [58.1%]), and aged <60 (n = 298 [32.9%]). RESULTS Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group (P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60-79 group (HR 0.97, 95%CI 0.51-1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60-79 group (HR 1.62, 95%CI 1.09-2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy. CONCLUSION Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA.
| | - Malcolm S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Marian S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Merieme M Klobocista
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA
| | - Dwight D Im
- The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Shinya Satoh
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Stephen H Bush
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Kosei Hasegawa
- Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA
| | | | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Tanja Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA
| | - Satoshi Takeuchi
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan
| | - Takuhei Yokoyama
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Keita Iwasaki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Takahito M Miyake
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan
| | - Tadao Takano
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan
| | - Mian Mk Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA
| | - Joseph L Kelley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA
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