2020, Number 3
<< Back Next >>
Revista Cubana de Obstetricia y Ginecología 2020; 46 (3)
Uterine carcinosarcoma. clinico-pathological characteristics, therapeutic management and survival
Samlall S, Sarria CM, Parellada JO
Language: Spanish
References: 32
Page: 1-26
PDF size: 630.86 Kb.
ABSTRACT
Introduction: Uterine carcinosarcomas are biphasic neoplasms, very aggressive and rare. They represent less than 5% of endometrial cancers, with high lethality.
Objective: To describe the clinical-pathological characteristics, therapeutic management and survival of uterine carcinosarcoma.
Methods: A retrospective descriptive study was carried out in 40 patients with a diagnosis of uterine carcinosarcoma, treated at the National Institute of Oncology and Radiobiology from 2009 to 2016. Qualitative and quantitative measures, hypothesis tests and survival analysis were used for statistical analysis, Kaplan-Meier statistical method and Long Rank test to compare survival by strata.
Results: The average age of the patients was 69.7 years. Hypertension (65.0%), diabetes mellitus (37.5%), and increased body weight index (52.5%) were the most frequent antecedents. Postmenopausal bleeding, increased uterine size, and the presence of a cervical polyp were the most common findings. 62.5% of the patients had advanced disease. Multimodal therapy was the most widely used. Recurrence arose in 66.6% of the patients. The overall survival rate at 1 year and 3 years was 47.5% and 11.7%, respectively. The overall disease-free survival at 3 years was 33.2%.
Conclusions: Uterine carcinosarcoma is a rare and very aggressive disease, diagnosed in advanced stages with high rate of recurrence and mortality, which is why early diagnosis, clinical and postoperative staging and the use of combined therapies for both stages are necessary. early and late.
REFERENCES
Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality 2018: GLOBOCAN sources and methods. Int J Cancer 2019 Apr 15;144(8):1941-53. Disponible en: DOI: https://doi.org/10.1002/ijc.31937
Ministerio de Salud Pública (MINSAP). República de Cuba. Anuario Estadístico de Salud 2017. La Habana: Dirección de Registros médicos y estadísticas de salud. MINSAP; [Internet]. 2018. [citado 28/09/2017]. Disponible en: https://temas.sld.cu/estadisticassalud/
Kanthan R and Senger JL, Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumor): A review with special emphasis on the controversies in management. Obstet Gynecol Int. 2011; 2011:470795. Disponible en: DOI: https://doi.org/10.1155/2011/470795
González Bosquet JS, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol. 2010 Mar;116(3):419–23. Disponible en: DOI: https://doi.org/10.1016/j.ygyno.2009.10.053
Zhan H, Chen F, Huang Y. Uterine Malignant Mixed Mullerian Tumor: Review of Recent Literature. N A J Med Sci. 2017;10(3):110-5. Disponible en: DOI: https://doi.org/10.7156/najms.2017.1003110
Jin Z, Ogata S, Tamura G, Katayama Y, Fukase M, Yajima M, et al. Carcinosarcomas (malignant müllerian mixed tumors) of the uterus and ovary: a genetic study with special reference to histogenesis. Int J of Gynecol Pathol. [Internet]. 2003 Oct [citado 28/09/2017];(4):368–73. Disponible en: https://www.researchgate.net/publication/9086825_Carcinosarcomas_Malignant_Mullerian_Mixed_Tumors_of_the_Uterus_and_Ovary_A_Genetic_Study_With_Special_Reference_to_Histogenesis
N’Kanza AL, Jobanputra S, Farmer P, Lovecchio J, Yelon JA, Rudloff U. Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus. Archives of Gynecology and Obstetrics. 2005;273(1):63–8. Disponible en: DOI: https://doi.org/10.1007/s00404-005-0004-3
De Jong RA, Nijman HW, Wijbrandi TF, Reyners AK, Boezen HM, and Hollema H. Molecular markers and clinical behavior of uterine carcinosarcomas: focus of the epithelial tumour component. Mod pathol. 2011Oct;24(10):1368-79. Disponible en: DOI: https://doi.org/10.1038/modpathol.2011.88
National Comprehensive Cancer Network (NCCN), NCCN Clinical Practice Guidelines in Oncology. [Internet]. 2019. [citado 28/09/2017]. Uterine Neoplasm Version. 1.2018. Disponible en: https://www.nccn.org/professionals/physician_gls/default.aspx
Garg G, Shah JP, Kumar S, Bryant CS, Munkarah A, Morris RT. Ovarian and uterine carcinosarcomas: a comparative analysis of prognostic variables and survival outcomes. Int J of Gynecol Cancer. 2010 Jul; 20(5):888–94. Disponible en: DOI: https://doi.org/10.1111/igc.0b013e3181dc8292
Grasso S, Loizzi V, Minicucci V, Resta L, Camporeale AL, Cicinelli E. Malignant mixed mullerian tumour of the uterus: Analysis de 44 cases. Oncology. 2017;92:197-204. Disponible en: DOI: https://doi.org/10.1159/000452277
Hembree TN, Teer JK, Hakam A, Chiappori AA. Genetic Investigation of Uterine Carcinosarcoma: Case Report and Cohort Analysis. J Mofitt Cancer Center. 2016 Jan;23(1):61-6. Disponible en: DOI: https://doi.org/10.1177/107327481602300111
Tanaka YO, Tsunoda H, Minami R, Yoshikawa H, and Minami M. Carcinosarcoma of the uterus: MR findings. J Magn Reson. Imaging. 2008;28(2):434–9. Disponible en: DOI: https://doi.org/10.6004/jnccn.2009.0037
Kernochan LE, Garcia RL. Carcinosarcomas (malignant mixed mullerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw. 2009 May;7(5):550–6; quiz 557. Disponible en: DOI: https://doi.org/10.6004/jnccn.2009.0037
Malca TM, López BA, Santos OC, Álvarez LM. Factores pronósticos para sobrevida en pacientes con Carcinosarcoma Uterino. Rev Perú Ginecol Obstet [Internet]. 2013 [citado 28/09/2017];59:119-24. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S230451322013000200007&lng=es
Rajshekar SK, Guruprasad B, Shakunthala PN, Rathod P, Devi U, and Bafna UD. Malignant mixed Mullerian tumour of the uterus. Ecancermedicalscience. 2013;7:302. Disponible en: DOI: https://dx.doi.org/10.3332/ecancer.2013.302
Wallwiener C, Hartkopf A, Kommoss S, Joachim C, Wallwiener M, Taran FA, et al. Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Carcinosarcoma: A Retrospective Case Series. Geburtshilfe Frauenheilkd. 2016;76(02):188-93. Disponible en: DOI: https://dx.doi.org/10.1055/s-0042-100205
Helpman L, Kupets R, Covens A, Saad RS, Khalifa MA, Ismiil N, et al. Assessment of endometrial sampling as a predictor of final pathology in endometrial cancer. Br J Cancer. 2014 Feb 4;110(3):609-15. Disponible en: DOI: https://doi.org/10.1038/bjc.2013.766.
Ray-Coquard I, Montesco MC, Coindre JM, Dei Tos AP, Lurkin A, Ranchère-Vince D et al, Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions. Ann Oncol. 2012 Sep;23(9):2442–9. Disponible en: DOI: https://doi.org/10.1093/annonc/mdr610
Kuyumcuoglu U, Kale A. Homologous type of malignant mixed Mullerian tumor of the uterus presenting as cervical mass. Journal of the Chinese Medical Association. 2009 Oct;72(10);533-5. Disponible en: DOI: https://doi.org/10.1016/S1726-4901(09)70423-X
Temkin SM, Hellmann M, Lee YC, O. Abulaia O. Early-stage carcinosarcoma of the uterus: the significance of lymph node count. Int J of Gynecol Cancer. 2007 Jan-Feb;17(1):215–9. Disponible en: DOI: https://doi.org/10.1111/j.1525-1438.2006.00762.x
Vorgias G. Fotiou S. The Role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Arch Gynecol Obstet. 2010 Dec;282(6): 659–64. Disponible en: DOI: https://doi.org/10.1007/s00404-010-1649-0
Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecologic Oncology. 2008;111(1):82–8. Disponible en: DOI: https://doi.org/10.1016/j.ygyno.2008.05.016
Garg G, Kruger M, Christensen C, Deppe G, and Toy EP. Stage III uterine carcinosarcoma: 2009 international federation of gynecology and obstetrics staging system and prognostic determinants. Int J Gynecol Cancer. 2011 Dec;21(9):1606-12. Disponible en: DOI: https://doi.org/10.1097/igc.0b013e31822265
Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL et al. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. Int J Gynecol Cancer. 2011;21(3):517–22. Disponible en: DOI: https://doi.org/10.1097/igc.0b013e31822265ad
Ulbricht LJ, Kunert M, Gremmler B, Evagelopoulos N, Krian A, Moege J. Intracardiac metastasis of a Malignant Mixed Mullerian Tumor (MMMT): progressive dyspnea due to obstruction of the leq atrium and the leq ventricle without leq ventricular dysfunction or primary lung disease. Wiener Medizinische Wochenschri. 2009;59(13-14):355–8. Disponible en: DOI: https://doi.org/10.1007/s10354-009-0698-0
Zwahlen DR, Schick U, Bolukbasi Y, Thariat J, Abdah-Bortnyak R, Abraham Kuten et al. Outcome and Predictive Factors in Uterine Carcinosarcoma using Postoperative Radiotherapy: A Cancer Network Study. Rare Tumors. 2016;8(2):6052. Disponible en: DOI: https://doi.org/10.4081%2Frt.2016.6052
Dave KS, Chauhan A, Bhansali R, Arora R, Purohit S. Uterine carcinosarcomas: 8-year single center experience of 25 cases. Indian J Med Paediatr Oncol. 2011 Jul-Sep;32(3):149–153. Disponible en: DOI: https://dx.doi.org/10.4103%2F0971-5851.92814
Tropé CG, Abeler VM, Kristensen GB. Diagnosis and treatment of sarcoma of the uterus. A review. Acta Oncol. 2012 Jul;51(6):694-705. Disponible en: DOI: https://doi.org/10.3109/0284186x.2012.689111
Wallwiener C, Hartkopf A, Kommoss S, Joachim C, Wallwiener M, Taran FA, et al. Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Carcinosarcoma: A Retrospective Case Series. Geburtsh Frauenheilk. 2016;76:188–93. Disponible en: DOI: https://dx.doi.org/10.1055/s-0042-100205
Safta IB, Jaidane O, Mansouri H, Doghri R, Chabchoub A, Hassouna JB, et al. Comparison of Survival and Prognostic Factors in Patients with Carcinosarcoma and Non Endometrioid Carcinoma of the Uterine Corpus. IOSR J Dent Med Sci (IOSR-JDMS). 2018 Sept;17(9);62-7. Disponible en: https://www.semanticscholar.org/paper/Comparison-of-Survival-And-Prognostic-Factors-In-of-Safta-Jaidane/d18bcb288aaa9d83893edabe9aae3efb1643368c. Disponible en: DOI: https://doi.org/10.9790/0853-1709076267
Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol. 2015 Jun;137(3):581-8. Disponible en: DOI: https://doi.org/10.1016/j.ygyno.2015.03.041