A Single Tertiary Site Review of Gynecologic Carcinosarcomas: Rising Incidence of A Lethal Disease

Abstract

OBJECTIVES: Carcinosarcoma of the uterus (utCASA) and ovary (ovCASA) appear to be rising in incidence. This study examined the incidence of utCASA and ovCASA at a single comprehensive cancer center (CCC) site in a 6-year period. We also evaluated the impact of clinicopathologic and treatment factors on median overall and progression free survival (MOS/PFS). METHODS: 933 consecutive uterine cancer and 366 consecutive ovarian cancer cases diagnosed between 1/2012-10/2018 were reviewed. Clinico-pathologic data were Oral Abstracted. Results were analyzed with R statistical software. RESULTS: Of 933 uterine cancers, 65 were utCASA (7%); of 366 ovarian cancer, 15 were ovCASA (4%). At the time of follow up (median length of 14 months), 61/80 (76%) of identified CASA cases were dead of disease. Median age at time of diagnosis was 70 for utCASA and 68 for ovCASA cohort. 17 patients with utCASA presented with stage I, 48 with stage III+IV disease, 3 unstaged (MOS 19 vs. 12 months, p=0.03. 2 patients with ovCASA presented with stage I+II, and 13 patients with stage III+IV disease (MOS 22 vs. 15 months). Among patients with utCASA, 35 were Caucasian, 14 African-American, 14 Latina, 2 Asian (MOS 12, 18, 9.5, 36 months, p= 0.84); of patients with ovCASA, 11 were Caucasian, 3 Latina, 1 Asian (MOS 14, 17, 7 months). In the entire cohort, 67/80 patients underwent extirpative pelvic surgery. Lymphadenectomy (LAD) was performed in 45/67 patients; 67% of patients were found to have positive lymph node involvement (LN+) (MOS LN+17 vs. LN-21 months, p=0.06). Of 30 patients with LN+, 20 had carcinomatous components, 8 patients had carcinomatous and sarcomatous components, 2 unidentified (MOS 18 vs. 16 months, p=0.48) Out of 65 utCASA cases, 53 underwent extirpative pelvic surgery. 35/53 had positive lympho-vascular space invasion (LVSI), 4 had indeterminate LVSI, 14 had no LVSI (MOS LVSI+ 18 vs. LVSI- 24 months, p= 0.15). Controlling for the aforementioned clinico-pathologic factors, adjuvant therapy with chemother-apy alone vs. chemo-radiation did not significantly affect MOS (p=0.2, figure 1) and PFS (p=0.78). CONCLUSIONS: Between 2012-2018, at a single CCC, the incidence of uCASA and ovCASA appears to be rising, as compared with historical cohorts. CASA appears to be almost uniformly fatal even at early stages. Patients with LVSI+ in utCASA, and LN+ in utCASA/ovCASA cohorts, demonstrated trends towards decreased MOS. Combining chemotherapy with pelvic radiation did not improve MOS/PFS. LEARNING OBJECTIVES: Learners will be able to estimate the incidence of uterine and ovarian carcinosarcoma at comprehensive cancer center sites, and appraise adjuvant therapy on an individual basis in light of an uniformly fatal disease despite clinicopathologic and therapy factors. ATTACHMENT: CASA_figs.pdf [Formula presented]