Optimal cytoreductive surgery in patients with advanced uterine carcinosarcoma: A multi-institutional retrospective study from the Japanese gynecologic oncology group

• We studied the impact of optimal surgery for advanced uterine carcinosarcoma (UCS).
• Optimal cytoreductive surgery improved overall survival of advanced UCS patients.
• Pelvic lymphadenectomy improved progression-free and overall survival.
• Our results reveal the potential benefits of optimal cytoreductive surgery.
• Our results support using pelvic lymphadenectomy as a standard surgical procedure.

BackgroundThe benefits of cytoreductive surgery for uterine carcinosarcoma (UCS) are unknown. The objective of this study was to determine the impact of optimal surgery on advanced UCS patient survival.MethodsWe performed a multi-institutional, retrospective study of women diagnosed with stage IIIIV UCS between 2007 and 2012. Data were obtained retrospectively from medical records, including demographic, clinicopathologic, treatment, and outcome information. Optimal cytoreductive surgery was defined as surgery resulting in a maximum residual tumor of ≤ 1 cm. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS), and the Cox regression model was used to examine the impact of selected factors on survival.ResultsA total of 225 UCS patients (median age, 63 years) were identified, including 136 (60%) with stage III and 89 (40%) with stage IV disease. Among these patients, 170 (76%) received optimal cytoreductive surgery. The median follow-up time was 19 months. The median PFS was 11.5 months (95% confidence interval [CI], 10.6–13.4) and 8.1 months (95% CI, 5.1–9.5) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P < 0.0001). The median OS was 37.9 months (95% CI, 28.3–not reached) and 18 months (95% CI, 9.6–21) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P < 0.0001). Residual tumor > 1 cm was associated with worse OS while pelvic lymph node dissection was associated with improved OS.ConclusionOptimal cytoreductive surgery and pelvic lymph node dissection are associated with improved OS in advanced UCS patients.