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Tang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, Qiu M. Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open 2023; 13:e077974. [PMID: 38101828 PMCID: PMC10729011 DOI: 10.1136/bmjopen-2023-077974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Carcinosarcoma (CS) is a rare and biphasic malignancy characterised by a highly invasive biological nature and poor prognosis. This study explored the epidemiology, site-specific characteristics and survival outcome of CS. DESIGN We conducted a retrospective study in the Surveillance, Epidemiology and End Results (SEER) database (1975-2018) for primary CS. SETTING AND PARTICIPANTS SEER database includes publicly available information from regional and state cancer registries in the US centres. A total of 5042 CS patients were identified. We selected the top five anatomic CS (uterus, double adnexa, lung, bladder and breast) patients for further analysis. PRIMARY OUTCOME MEASURES Incidence was estimated by geographical region, age, sex, race, stage and primary site. Trends were calculated using joinpoint regression. The cancer-specific survival (CSS) rate and initial treatment were summarised. RESULTS Nearly 80% of CS occurred in the uterus and double adnexa, followed by lung, bladder and breast. The elderly and black population presented the highest age-adjusted rate of CS. The rates of distant metastasis in CS progressively increased from 1989 to 2018. Atlanta was the area with the highest incidence at 0.7 per 100 000. Pulmonary and bladder CS more frequently occurred in men and were diagnosed with regional stage. Distant metastasis was mostly found in ovary/fallopian tube CS. Radiotherapy was more commonly applied in uterine CS, while adnexa CS cases were more likely to receive chemotherapy. Multiple treatments were more used in breast CS. Pulmonary CS seemed to suffer worse CSS (median: 9.92 months), for which radiotherapy might not provide survival benefits (HR 0.60, 95% CI 0.42 to 0.86). Compared with the common histological types in each site, CS had the shortest survival. CONCLUSIONS CS has unique clinical features in each primary site. Substantial prognosis variances exist based on tumour locations. The aggressive course is the common feature in CS at all sites.
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Affiliation(s)
- Lian-Sha Tang
- West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Wen Zhou
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Ling Wang
- West China Hospital of Sichuan University, Chengdu, China
| | - Guo-Xu Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | - Chen-Hao Xu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Abdominal Oncology, West China Hospital of Sichuan University, Chengdu, China
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Makk E, Bohonyi N, Oszter A, Éles K, Tornóczky T, Tóth A, Kálmán E, Kovács K. Comparative analysis of EZH2, p16 and p53 expression in uterine carcinosarcomas. Pathol Oncol Res 2023; 29:1611547. [PMID: 38146588 PMCID: PMC10749357 DOI: 10.3389/pore.2023.1611547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
Introduction: The role of p16 and p53 immunohistochemistry in the diagnosis of rare and aggressive uterine carcinosarcoma (UCS) has been well established. However, enhancer of zeste homolog 2 (EZH2), a histone methyltransferase and a member of the polycomb group family is a relatively new biomarker, with limited published data on its significance in this tumor type. The goal of this study was to examine EZH2 expression in UCS and its components, in correlation with morphological features, and p16 and p53 staining patterns. Methods: Twenty-eight UCSs were included in the study. EZH2, p16 and p53 immunoreactivity were assessed independently by two pathologists in both tumor components (epithelial and mesenchymal). EZH2 and p16 immunostains were scored semiquantitatively: based on the percentage and intensity of tumor cell staining a binary staining index ("high- or low-expressing") was calculated. The p53 staining pattern was evaluated as wild-type or aberrant (diffuse nuclear, null, or cytoplasmic expression). Statistical tests were used to evaluate the correlation between staining patterns for all three markers and the different tumor components and histotypes. Results: High EZH2 and p16 expression and aberrant p53 patterns were present in 89.3% 78.6% and 85.7% of the epithelial component and in 78.6%, 62.5% and 82.1% of the mesenchymal component, respectively. Differences among these expression rates were not found to be significant (p > 0.05). Regarding the epithelial component, aberrant p53 pattern was found to be significantly (p = 0.0474) more frequent in the serous (100%) than in endometrioid (66.6%) histotypes. Within the mesenchymal component, p53 null expression pattern occurred significantly (p = 0.0257) more frequently in heterologous sarcoma components (71.4%) compared to the homologous histotype (18.8%). Conclusion: In conclusion, EZH2, p16 and p53 seem to play a universal role in the pathogenesis of UCS; however, a distinctive pattern of p53 expression appears to exist between the serous and endometrioid carcinoma components and also between the homologous and heterologous sarcoma components.
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Affiliation(s)
- Evelin Makk
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Noémi Bohonyi
- Department of Obstretrics and Gynaecology, University of Pécs Medical School, Pécs, Hungary
| | - Angéla Oszter
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Klára Éles
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Tornóczky
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Arnold Tóth
- Department of Medical Imaging, University of Pécs Medical School, Pécs, Hungary
| | - Endre Kálmán
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Krisztina Kovács
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
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Laguna-Hernández P, Mendoza-Moreno F, Bru-Aparicio M, Alvarado-Hurtado R, Soto-Schütte S, Serrano-Yébenes E, Allaoua-Moussaoui Y, Mañes-Jiménez F, Jiménez-Martín R, Jiménez-Alvarez L, Córdova-Garcia D, Diez-Alonso MM, Gutiérrez-Calvo A. Uterine carcinosarcoma with intestinal involvement: A case report and literature review. MEDICINE INTERNATIONAL 2023; 3:15. [PMID: 36925759 PMCID: PMC10012404 DOI: 10.3892/mi.2023.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Uterine carcinosarcoma (UCS) is a high-grade endometrial cancer characterized by two components: Carcinomatous (epithelial) and sarcomatous (stromal tissue) elements. The present study describes a clinical case of this type of UCS and also provides a brief literature review of this type of tumor. A 72-year-old female visited the emergency department of the authors' hospital with pain in the hypogastric region, intestinal dysrhythmia since 3 months prior, fever and a palpable abdominal mass. Laboratory test results revealed sepsis and mild anemia and an imaging test revealed a large uterine tumor with wide areas of necrosis and adenopathies. As determined by the multidisciplinary committee, surgery was considered the main treatment option and this was performed with no incidences. Carcinosarcoma is a rare tumor, which most frequently occurs in older women. The diagnosis is based on symptoms and imaging tests, such as ecography and scans. The gold standard of treatment is surgery, although it is possible that other types of therapies, such as chemotherapy and radiotherapy may also be effective, depending on the tumor stage. On the whole, the prognosis of patients with this type of tumor is poor, with a low survival rate, even in earlier stages due to its malignant component and the possibility for metastasis. Surgery is the optimal treatment for this type of tumor, if this is possible, always individualizing patients.
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Affiliation(s)
- Pilar Laguna-Hernández
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Fernando Mendoza-Moreno
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Marta Bru-Aparicio
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Ricardo Alvarado-Hurtado
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Sonia Soto-Schütte
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Eduardo Serrano-Yébenes
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Youssef Allaoua-Moussaoui
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Felix Mañes-Jiménez
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Rubén Jiménez-Martín
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Laura Jiménez-Alvarez
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Diego Córdova-Garcia
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Manuel Mariano Diez-Alonso
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
| | - Alberto Gutiérrez-Calvo
- General Surgery Service, Príncipe de Asturias University Hospital, Alcalá de Henares, 28805 Madrid, Spain
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Chen S, Zhu J, Wang P, Wan D, Cui X, Xu Y, Zhang X, Yin H, Chen X, Cai J, Yang X. PD-L1 expression and intra-tumoral CD8 + T lymphocytes in esophageal carcinosarcoma. Cancer Invest 2022; 40:337-347. [PMID: 35100066 DOI: 10.1080/07357907.2022.2029474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We detected PD-L1 and intra-tumoral CD8+ T lymphocytes (CD8+ TIL) in 19 patients with esophageal carcinosarcoma (ECS). The median follow-up period of these patients was 43 months, and the three- and five-year survival rates were 78.9% and 63.2%, respectively. No statistically significant correlation was observed between PD-L1 and CD8+ TIL in sarcomatous components(SC) (r = -0.262, P = 0.279) and epithelial carcinomatous (EC) (r = 0.055, P = 0.824).This study examined the immunological markers in ECS for the first time. PD-L1 is highly expressed in the SC and is associated with a poorer prognosis.
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Affiliation(s)
- Shusen Chen
- Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Jiamin Zhu
- Department of Oncology, Jiangyin People's Hospital, Jiangyin 214400, China
| | - Peng Wang
- Department of Oncology, Taizhou people's Hospital, Taizhou, Jiangsu, 225300, China
| | - Dongdong Wan
- Department of Oncology, Haimen People's Hospital, Nantong,226100, China
| | - Xiaojia Cui
- Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Yunzhao Xu
- Department of Obstetrics and Gynecology, Nantong University Affiliated Hospital, Nantong 226001, Jiangsu, China
| | - Xingsong Zhang
- Department of Pathology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Haibin Yin
- Department of Pathology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Xudong Chen
- Department of Pathology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Jing Cai
- Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, 226321, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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