Patterns of care, predictors and outcomes of chemotherapy for ovarian carcinosarcoma: A National Cancer Database analysis

Rauh‐Hain, J. Alejandro; Gonzalez, Rafael; Bregar, Amy; Clemmer, Joel; Hernández-Blanquisett, Abraham; Clark, Rachel M.; Schorge, John O.; Carmen, Marcela G. del

doi:10.1016/j.ygyno.2016.04.025

Cited by 32 publications

(30 citation statements)

References 25 publications

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“…Although other studies have demonstrated a survival benefit for those diagnosed with early-stage disease, our cohort did not demonstrate improved survival or a decrease in recurrence. A National Cancer Database analysis also found a decrease in both cancer-specific and OS when compared to serous ovarian carcinoma across all stages [7]. Similar results were found in a review of 1334 women with CSO from patients in the SEER database from 1998-2009 in which nearly all factors were independently predictive for worse cancer-specific survival for those with CSO compared with serous carcinoma of the ovary [5].…”

Section: Discussionsupporting

confidence: 66%

“…A similarly sized cohort treated at Memorial Sloan-Kettering Cancer Center found that treatment with carboplatin/taxol may be a suitable first-line chemotherapy regimen with a median survival of 43 months in 30 treated patients [11]. Due to the rarity of CSO, the GOG stated that we will likely need to extrapolate treatment options from those with uterine carcinosarcoma as it will be increasingly difficult to set up and complete a randomized controlled trial [7]. A case-control study comparing treatment in 50 women with CSO to 100 controls found that with platinum and taxane based chemotherapy those with CSO had decreased PFS by 5 months and decreased OS of 17 months [12].…”

Section: Discussionmentioning

confidence: 99%

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Overall Survival and Adjuvant Therapy in Women with Ovarian Carcinosarcoma: A Single-Institution Experience

et al. 2019

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Background: Carcinosarcoma of the ovary (CSO) is a rare and aggressive variant of ovarian cancer. Due to the rare nature of the disease there is insufficient evidence to make recommendations regarding standard management and overall prognosis. Methods: An Institutional Review Board-approved study identified all our patients with CSO between January 2011 and May 2018. Demographic and outcome measures were abstracted from the medical records and tumor board files. Cox proportional hazard models, log rank tests, and comparisons of means were used to calculate significance (p < 0.05). Results: 27 women with CSO were identified. The median age at diagnosis was 65 years (range 48–91). Five women (18%) presented with early stage disease (Stage I or II) and 22 patients (82%) presented with late stage III or IV disease. Twenty patients (74%) received intravenous platinum-based combination chemotherapy. Seven patients did not receive chemotherapy during their treatment course. The median overall survival was 23 months (range 2–68 months). Overall survival was not significantly worsened by the stage of disease at diagnosis. There was no difference in survival based on the age at diagnosis, tobacco status or ethnicity (p > 0.05). Conclusion: This is one of the largest single institution experiences with CSO. The majority of our patients presented with advanced stage disease and received adjuvant platinum-based chemotherapy after cytoreductive surgery. The median overall survival of 23 months was not affected by the stage of the disease. The optimal management of this rare disease needs further study with collaborative, prospective multi-institutional trials.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Overall Survival and Adjuvant Therapy in Women with Ovarian Carcinosarcoma: A Single-Institution Experience

et al. 2019

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“…Although surgical debulking followed by adjuvant chemotherapy remains the mainstay of treatment for ovarian carcinosarcoma, low response rates and high recurrence rate is a major concern for the majority of patients [ 2 ]. Moreover, the five-year survival rate for OCS is 26.63% compared to 43.61% for serous carcinomas [ 17 ]. Cancer immunotherapy is now rapidly evolving with clinical benefits targeting the PD-1/PD-L1 pathways.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Programmed Death Ligand‑1 and Intra-Tumoral CD8+ T Lymphocytes in Ovarian Carcinosarcoma

Zhu

Wen

et al. 2017

PLoS ONE

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Ovarian carcinosarcoma (OCS) accounts for high mortality and lacks effective therapeutic methods. So far, we lack reliable biomarkers capable of predicting the risk of aggressive course of the disease. Programmed death ligand-1 (PD-L1) is expressed in various tumors, and antibodies targeting its receptor programmed cell death 1 (PD-1) are emerging cancer therapeutics. This study was designed to evaluate the expression of PD-L1 and intratumoral CD8+ T lymphocytes by immunohistochemistry from 19 OCS patients who underwent primary surgery at Fudan University Shanghai Cancer Center. The correlations between PD-L1 expression and CD8+ T lymphocytes as well as the patients’ clinicopathologic characteristics were integrated and statistically analyzed. PD-L1-positive expression was observed in 52.6% of intraepithelial tissues and 47.4% of mesenchymal tissues (p = 0.370). Meanwhile, intraepithelial and mesenchymal CD8+ T lymphocytes were positive in 36.8% and 84.2% of OCS, respectively (p = 0.628). A significantly negative correlation was found between mesenchymal CD8+ T lymphocytes and PD-L1 expression (r = -0.630, p = 0.011). Intraepithelial PD-L1-positive expression was associated only with positive ascitic fluid (p = 0.008). Mesenchymal PD-L1-positive patients had a poorer survival than those with negative expression (p = 0.036). Meanwhile, intraepithelial PD-L1-positive patients had a better survival trend than PD-L1-negative patients, though no statistical significance was found (p = 0.061). There was a better postoperative survival noted in mesenchymal CD8-positive patients (p = 0.024), and allthough a better trend of OS was observed in intraepithelial CD8-positive patients, no statistical significance was found (p = 0.382). Positive tumoral CD8+ T lymphocytes and mesenchymal PD-L1-negative expression seem to be associated with better survival in OCS. It is possible that immunotherapy targeting PD-L1 pathway could be used in OCS.

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“…Retrospective studies that assessed the survival of women with ovarian carcinosarcoma compared to other histologies[55]. a N: number of patients; OS: overall survival; CI: Confidence Interval; aHR: Adjusted Hazard Ratio; SEER: Surveillance, Epidemiology, and End Results; OCS: ovarian carcinosarcoma; EOC: epithelial ovarian cancer; HGPS: high-grade papillary serous.…”

mentioning

confidence: 99%

“Carcinosarcoma of the ovary, fallopian tube, and peritoneum: Prognostic factors and treatment modalities”

Rauh‐Hain

Birrer

Carmen

2016

Gynecologic Oncology

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Patterns of care, predictors and outcomes of chemotherapy for ovarian carcinosarcoma: A National Cancer Database analysis

Cited by 32 publications

References 25 publications

Overall Survival and Adjuvant Therapy in Women with Ovarian Carcinosarcoma: A Single-Institution Experience

Overall Survival and Adjuvant Therapy in Women with Ovarian Carcinosarcoma: A Single-Institution Experience

Clinical Significance of Programmed Death Ligand‑1 and Intra-Tumoral CD8+ T Lymphocytes in Ovarian Carcinosarcoma

“Carcinosarcoma of the ovary, fallopian tube, and peritoneum: Prognostic factors and treatment modalities”

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