JOURNAL of
ONCOLOGICAL
SCIENCES

ORIGINAL RESEARCH ARTICLE

Optimal Cytoreduction is an Independent Prognostic Factor in Ovarian Carcinosarcoma: A Turkish Gynecologic Oncology Group Study
Received Date : 23 Dec 2019
Accepted Date : 29 Mar 2020
Available Online : 24 Jun 2020
Doi: 10.37047/jos.2019-73073 - Article's Language: EN
J Oncol Sci.2020;6(2):78-86
This is an open access article under the CC BY-NC-ND license
ABSTRACT
Objective: To determine prognostic factors for women with ovarian carcinosarcoma (OCS). Material and Methods: A multicenter, retrospective department database review was performed to identify patients with OCS at eight gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. Results: We identified 94 patients with OCS. The median age was 60.0 years (range, 31-78), and the median follow-up duration was 36.0 months (range, 4-188). After primary cytoreductive surgery, 61 (64.9%) patients had ≤1 cm of residual disease (optimal debulking), whereas 33 (35.1%) had >1 cm of residual disease (suboptimal debulking). For the entire cohort, the 5-year progression free survival (PFS) rate was 25.2%, whereas the 5-year overall survival (OS) rate was 49.4%. Women with optimal cytoreduction had a median PFS of 41.0 months (95% Confidence Interval [CI]: 19.71-62.28, Standard Error [SE]: 10.86) compared with women with suboptimal cytoreduction who had a median PFS of 15.0 months (95% CI: 8.79-21.21, SE: 3.16; p=0.011). The 5 year OS rate for women with optimal cytoreduction was significantly higher than that of women with suboptimal debulking (57.6% vs. 33.9%; p=0.005). Positive peritoneal cytology (hazard ratio [H]: 2.35, 95% CI: 1.19-4.63; p=0.013) and suboptimal cytoreduction (H: 2.61, 95% CI: 1.32-4.99; p=0.004) were independent risk factors for decreased OS. Conclusion: Suboptimal cytoreduction seems to be an independent prognostic factor for decreased OS in women with OCS.
REFERENCES
  1. Harris MA, Delap LM, Sengupta PS, et al. Carcinosarcoma of the ovary. Br J Cancer. 2003;88(5):654-657. [Crossref]  [PubMed]  [PMC] 
  2. Brown E, Stewart M, Rye T, et al. Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer. 2004;100 (10):2148-2153. [Crossref]  [PubMed] 
  3. Signorelli M, Chiappa V, Minig L, et al. Platinum, anthracycline, and alkylating agent-based chemotherapy for ovarian carcinosarcoma. Int J Gynecol Cancer 2009;19(6): 1142-1146. [Crossref]  [PubMed] 
  4. Wada H, Enomoto T, Fujita M, et al. Molecular evidence that most but not all carcinosarcomas of the uterus are combination tumors. Cancer Res. 1997;57(23):5379-5385.
  5. Jin Z, Ogata S, Tamura G, et al. Carcinosarcomas (malignant mullerian mixed tumors) of the uterus and ovary: a genetic study with special reference to histogenesis. Int J Gynecol Pathol. 2003;22(4):368-373. [Crossref]  [PubMed] 
  6. Pacaut C, Bourmaud A, Rivoirard R, et al. Uterine and ovary carcinosarcomas: outcome, prognosis factors, and adjuvant therapy. Am J Clin Oncol. 2015;38(3):272-277. [Crossref]  [PubMed] 
  7. Matsuo K, Bond VK, Im DD, Rosenshein NB. Prediction of chemotherapy response with platinum and taxane in the advanced stage of ovarian and uterine carcinosarcoma: a clinical ımplication of ın vitro drug resistance assay. Am J Clin Oncol. 2010;33(4):358-363. [Crossref]  [PubMed] 
  8. Berton-Rigaud D, Devouassoux-Shisheboran M, Ledermann JA, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for uterine and ovarian carcinosarcoma. Int J Gynecol Cancer. 2014;24(9 suppl 3):S55-60. [Crossref]  [PubMed] 
  9. Shylasree TS, Bryant A, Athavale R. Chemotherapy and/or radiotherapy in combination with surgery for ovarian carcinosarcoma. Cochrane Database Syst Rev. 2013;(2):CD006246. [Crossref]  [PubMed]  [PMC] 
  10. Tate Thigpen J, Blessing JA, DeGeest K, Look KY, Homesley HD; Gynecologic Oncology G. Cisplatin as initial chemotherapy in ovarian carcinosarcomas: a Gynecologic Oncology Group Study. Gynecol Oncol. 2004;93(2):336-339. [Crossref]  [PubMed] 
  11. del Carmen MG, Birrer M, Schorge JO. Carcinosarcoma of the ovary: a review of the literature. Gynecol Oncol. 2012;125(1):271-277. [Crossref]  [PubMed] 
  12. Inthasorn P, Beale P, Dalrymple C, Carter J. Malignant mixed mullerian tumour of the ovary: prognostic factor and response of adjuvant platinum-based chemotherapy. Aust N Z J Obstet Gynaecol. 2003;43(1):61-64. [Crossref]  [PubMed] 
  13. Rauh-Hain JA, Growdon WB, Rodriguez N, et al. Carcinosarcoma of the ovary: a case-control study. Gynecol Oncol. 2011;121(3):477-481. [Crossref]  [PubMed] 
  14. Rutledge TL, Gold MA, McMeekin DS, et al. Carcinosarcoma of the ovary-a case series. Gynecol Oncol. 2006;100(1):128-132. [Crossref]  [PubMed] 
  15. Chun KC, Kim JJ, Kim DY, et al. Optimal debulking surgery followed by paclitaxel/platinum chemotherapy is very effective in treating ovarian carcinosarcomas: a single center experience. Gynecol Obstet Invest. 2011;72(3): 208-214. [Crossref]  [PubMed] 
  16. Duska LR, Garrett A, Eltabbakh GH, Oliva E, Penson R, Fuller AF. Paclitaxel and platinum chemotherapy for malignant mixed mullerian tumors of the ovary. Gynecol Oncol. 2002;85(3):459-463. [Crossref]  [PubMed] 
  17. Silasi DA, Illuzzi JL, Kelly MG, et al. Carcinosarcoma of the ovary. Int J Gynecol Cancer. 2008;18(1):22-29. [Crossref]  [PubMed] 
  18. Jernigan AM, Fader AN, Nutter B, Rose P, Tseng JH, Escobar PF. Ovarian carcinosarcoma: effects of cytoreductive status and platinum-based chemotherapy on survival. Obstet Gynecol Int. 2013;2013:490508. [Crossref]  [PubMed]  [PMC] 
  19. Doo DW, Erickson BK, Arend RC, Conner MG, Huh WK, Leath CA 3rd. Radical surgical cytoreduction in the treatment of ovarian carcinosarcoma. Gynecol Oncol. 2014;133(2): 234-237. [Crossref]  [PubMed]  [PMC] 
  20. 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 Gynecol Cancer. 2010;20(5):888-894. [Crossref]  [PubMed] 
  21. Paulsson G, Andersson S, Sorbe B. A population-based series of ovarian carcinosarcomas with long-term follow-up. Anticancer Res. 2013;33(3):1003-1008.
  22. Lu CH, Chen IH, Chen YJ, et al. Primary treatment and prognostic factors of carcinosarcoma of the ovary, fallopian tube, and peritoneum: a Taiwanese Gynecologic Oncology Group Study. Int J Gynecol Cancer. 2014;24(3):506-512. [Crossref]  [PubMed] 
  23. Cicin I, Saip P, Eralp Y, et al. Ovarian carcinosarcomas: clinicopathological prognostic factors and evaluation of chemotherapy regimens containing platinum. Gynecol Oncol. 2008;108(1):136-140. [Crossref]  [PubMed] 
  24. Seidman JD RP, Kurman RJ. Surface epithelial tumors of the ovary. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract. 5th ed. New York: Springer Verlag; 2002:791-904.
  25. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol. 1989;96(8):889-892. [Crossref]  [PubMed] 
  26. Yalcin I, Meydanli MM, Turan AT, et al. Carcinosarcoma of the ovary compared to ovarian high-grade serous carcinoma: impact of optimal cytoreduction and standard adjuvant treatment. Int J Clin Oncol. 2018;23(2):329-337. [Crossref]  [PubMed] 
  27. Sood AK, Sorosky JI, Gelder MS, et al. Primary ovarian sarcoma: analysis of prognostic variables and the role of surgical cytoreduction. Cancer. 1998;82(9):1731-1737. [Crossref] 
  28. Leiser AL, Chi DS, Ishill NM, Tew WP. Carcinosarcoma of the ovary treated with platinum and taxane: the memorial Sloan-Kettering Cancer Center experience. Gynecol Oncol. 2007;105(3):657-661. [Crossref]  [PubMed] 
  29. Mano MS, Rosa DD, Azambuja E, et al. Current management of ovarian carcinosarcoma. Int J Gynecol Cancer. 2007;17(2):316-324. [Crossref]  [PubMed] 
  30. Barnholtz-Sloan JS, Morris R, Malone JM Jr, Munkarah AR. Survival of women diagnosed with malignant, mixed mullerian tumors of the ovary (OMMMT). Gynecol Oncol. 2004;93(2): 506-512. [Crossref]  [PubMed] 
  31. Rauh-Hain JA, Gonzalez R, Bregar AJ, et al. Patterns of care, predictors and outcomesof chemotherapy for ovarian carcinosarcoma: a National Cancer Database analysis. Gynecol Oncol. 2016;142(1):38-43. [Crossref]  [PubMed] 
  32. Nishikawa T, Hasegawa K, Yabuno A, et al. Pazopanib as a second line treatment for uterine and ovarian carcinosarcoma: a Single Institutional Study. J Gynecol Oncol. 2017;28(1): e25. [Crossref]  [PubMed]  [PMC] 
  33. Gynecologic Oncology Group. A Randomized Phase III Trial of Paclitaxel Plus Carboplatin Versus Ifosfamide Plus Paclitaxel in Chemotherapy-Naive Patients With Newly Diagnosed Stage I-IV, Persistent or Recurrent Carcinosarcoma (Mixed Mesodermal Tumors) of the Uterus, Fallopian Tube, Peritoneum or Ovary [internet]. Verified [cited 2019 January 15].