Prognostic determinants in patients with uterine and ovarian carcinosarcoma

OBJECTIVE: To analyze and compare the demographics, treatment, recurrence, and survival rates in patients with carcinosarcoma of the uterus and ovary. STUDY DESIGN: All patients with uterine and ovarian carcinosarcoma who underwent surgical staging at the 2 participating institutions between 1995 and 2007 were identified. The Kaplan-Meier method was used to generate overall survival (OS) data. Factors predictive of outcome were compared using the Cox proportional hazards model. RESULTS: Analysis of 87 women with uterine carcinosarcoma and 71 with ovarian carcinosarcoma was performed. Of those, 47% of the patients with uterine carcinosarcoma, compared to 14% of the patients with ovarian carcinosarcoma, were diagnosed with localized disease (p<0.001). Age > 65 years old (p<0.001), tumor extension (local versus regional versus distant, p<0.001), and platinum-based chemotherapy (p=0.05) were all independent predictors of survival. In a multivariate Cox regression model, age > 65 years old (hazard ratio [HR]= 2.5, p < 0.001), tumor extension (locoregional versus distant, HR=3.9, p=0.006), and uterine versus ovarian carcinosarcoma (HR = 2.2, p = 0.009) were identified as independent predictors of OS. CONCLUSION: Uterine carcinosarcoma presents at an earlier stage than does ovarian carcinosarcoma. In the multivariate analysis uterine carcinosarcoma demonstrated shorter survival than did ovarian carcinosarcoma after adjustment for extent of disease spread, age, and platinum-based chemotherapy.