Comparison of survival outcomes among patients with uterine carcinosarcoma and those with grade 3 uterine carcinoma: A systematic review of the literature

Introduction: Endometrial carcinosarcoma is an aggressive form of cancer that has been classified in type II endometrial carcinomas. However, survival outcomes seem to differ considerably compared to grade 3 endometrioid adenocarcinoma, the predominant form of cancer in this group of patients. The purpose of the present systematic review is to investigate overall and progression free survival in patients with endometrial carcinosarcoma to those of patients with grade 3 endometrioid adenocarcinoma. Methods: We used Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases. Statistical analysis was performed using the Sidik-Jonkman random effect model (REM) in Rstudio. Findings: Overall, 10.121 patients from 8 studies were investigated. The results of the present meta-analysis indicate that patients with Gr3EC had better overall survival rates HR 2.41 (95% CI 1.29, 4.51). However, this effect might be influenced by selection bias and underpowered studies as following adjustment of the aggregated estimate for small study effects we observed that it was not significant (HR 1.00, 95%CI 0.96, 1.05, p=.858). Although it was not possible to accumulate data concerning the progression free survival, individual studies reported worse outcomes in patients with carcinosarcoma. Conclusions: Carcinosarcoma is a particularly aggressive form of endometrial cancer and deserves further attention from researchers as current treatment alternatives do not seem to reach survival outcomes of patients suffering from grade 3 endometrioid adenocarcinoma.