Overall survival after progression in patients with uterine carcinosarcoma: a single-center retrospective cohort study.

Abstract

Objective: To investigate 2-year overall survival (OS) after progression in patients with uterine carcinosarcoma (UCS).

Methods: This retrospective descriptive cohort study included patients diagnosed with progressive UCS at all stages, who underwent surgical staging with or without adjuvant therapy between January 2002 and December 2022. Clinicopathological characteristics, including recurrence patterns, were assessed using descriptive statistics, Fisher's exact test, and the chi-squared test. Prognostic factors and OS after progression were analyzed using the Cox proportional hazards model and Kaplan-Meier method, respectively.

Results: Fifty-four patients (mean age, 61 years) were eligible for analysis. During primary treatment, 40 patients underwent optimal surgery, 44 received adjuvant chemotherapy with or without radiotherapy, and 43 developed progressive disease within the first 2 years (median progression-free interval: 10.5 months). Overall, 74.07% of patients developed distant or combined metastases. During salvage treatment, 22 patients received chemotherapy, 11 received a combination of chemotherapy and radiotherapy, and five underwent radiotherapy alone. The median follow-up period was 18 months, with a 2-year OS rate of 20% post-progression. Multivariate analysis revealed that leukocytosis at progression was associated with decreased survival (hazard ratio [HR], 5.98; 95% confidence interval [CI], 2.33-15.3; P<0.001). Notably, optimal primary surgery (HR, 0.31; 95% CI, 0.13-0.72; P=0.006) and chemoradiotherapy as salvage treatment (HR, 0.23; 95% CI, 0.08-0.7; P=0.009) significantly improved survival.

Conclusion: Patients with progressive UCS have poor OS. Optimal surgery as primary treatment combined with salvage chemoradiotherapy improves post-progression survival. Leukocytosis during disease progression significantly affects survival outcomes.