The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review

Vorgias, George; Fotiou, Stelios

doi:10.1007/s00404-010-1649-0

Cited by 49 publications

(42 citation statements)

References 36 publications

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“…The finding that removal of lymph nodes improves survival is in accordance with previous publications [2, 5, 6, 10]. In the largest study, Nemani et al [2] evaluated the role of lymph node dissection in 1,855 patients with stage I–III UCS using data from the Surveillance, Epidemiology, and End Results (SEER) program in the USA.…”

Section: Discussionsupporting

confidence: 73%

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Versluis

Pielsticker

et al. 2018

Oncology

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Objective: Uterine carcinosarcoma is a rare, aggressive subtype of endometrial cancer. Treatment consists of hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy (LND). The survival benefit of LND in relation to adjuvant radio- and/or chemotherapy is unclear. We evaluated the impact of LND on survival in relation to adjuvant therapy in uterine carcinosarcoma. Methods: Retrospective data on 1,140 cases were combined from the Netherlands Cancer Registry (NCR) and the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). LND was defined as the removal of any nodes. Additionally, cases where 10 nodes or less (LND ≤10) or more than 10 nodes (LND > 10) were removed were analyzed separately. Adjuvant therapy was evaluated as radiotherapy, chemotherapy, or radiochemotherapy. Associations were analyzed by χ² test, log-rank test, and Cox regression analysis. Results: Overall survival (OS) had improved after total abdominal hysterectomy with bilateral salpingo-oophorectomy with LND > 10 (HR 0.62, 95% CI 0.47–0.83). Adjuvant therapy was related to OS with an HR of 0.64 (95% CI 0.54–0.75) for radiotherapy, an HR of 0.65 (95% CI 0.48–0.88) for chemotherapy, and an HR of 0.25 (95% CI 0.13–0.46) for radiochemotherapy. Additionally, adjuvant treatment was related to OS when lymph nodes were positive (HR 0.22, 95% CI 0.11–0.42), but not when they were negative. Conclusion: LND is related to improved survival when more than 10 nodes are removed. Adjuvant therapy improves survival when LND is omitted, or when nodes are positive.

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Section: Discussionsupporting

confidence: 73%

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Versluis

Pielsticker

et al. 2018

Oncology

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“…This procedure was performed on 97.7% of our patients. The role of lymphadenectomy remains undetermined [26] ; in our study, 8 patients underwent pelvic lymphadenectomy, while 5 underwent only lymph node sampling. Also the optimal number of lymph nodes to be sampled remains undetermined [27] .…”

Section: Discussionmentioning

confidence: 99%

“…In the literature the presentation of MMMT in advanced stages has been described in 50-60% of cases [15,32] , and in multivariate analyses stage has been reported as the most important prognostic factor [26] predicting patient outcome [7] . As regards our experience, even if statistically there was no significant difference in survival, median Probably also the small sample size affected our results -compared to most reports that point out a correlation between advanced stage and reduced overall survival, with 5-year survival rates of 30-46% with stage I/II carcinosarcomas and of 0-10% with advanced tumours [4] .…”

Section: Discussionmentioning

confidence: 99%

“…The patient who underwent radiotherapy alone had a pelvic recurrence 8 months after surgery; survival was 11 months from the diagnosis. Thus, even if the literature has shown that adjuvant radiotherapy may contribute to decreased pelvic recurrences, its impact on patient survival remains controversial [26] . It has been suggested that a multimodality treatment, including a combination of chemotherapy and radiation therapy, may be effective in improving survival compared to surgery, chemotherapy, or radiotherapy alone [2,34] .…”

Section: Discussionmentioning

confidence: 99%

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Malignant Mixed Müllerian Tumour of the Uterus: Analysis of 44 Cases

et al. 2017

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Objectives: The aim of our study was to evaluate the clinicopathological features and prognostic factors of uterine carcinosarcoma. Patients and Methods: In this retrospective study, the clinical characteristics of 44 patients with uterine MMMT were evaluated. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. Results: Forty-four patients with uterine carcinosarcoma were referred to our unit between 1995 and 2015. Their median age was 66.5 years. All women underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Twenty-five percent had omental resection. Pelvic lymphadenectomy was performed in 18.2% of the cases. Twenty-six of the patients presented with stage I/II disease, 17 with advanced stages. In 20.5% of the cases there were metastases at diagnosis. Forty women received adjuvant chemotherapy, with complete remission in 67.9% of the cases. Recurrences were observed in 27.3% of the women. Disease-free and overall survival was 27 and 103 months, respectively. The FIGO stage, histological type, tumour size, chemotherapy regimen, pelvic lymphadenectomy, and myometrial invasion did not affect survival. Conclusions: Uterine MMMT is an aggressive tumour, often diagnosed at an advanced stage and with a high rate of metastases or recurrences. Because of its rarity, its management is controversial and fixed prognostic factors cannot be defined.

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“…Lymph node involvement occurs in 14% to 38% of cases, and they respond better to chemotherapy than sarcomas. 17,18 There are other types of sarcomas, but they are very rare neoplasias. Embryonal rhabdomyosarcomas are often observed in young patients and can be found in several gynecological location.…”

Section: 16mentioning

confidence: 99%

Clinical and molecular features of uterine sarcomas

Almeida¹,

Cunha²,

Maciel³

et al. 2014

Medical Express

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INTRODUCTION: Uterine sarcomas are rare forms of malignant neoplasm, comprising about 3% of all malignant uterine tumors, representing less than 1% of all gynecologic malignancies. Low cure rates often occur due mainly to distant metastases, usually to the lungs. Aggressiveness, high rates of local recurrence, distant metastasis and poor prognosis with overall two-year survival less than 50% are common features of uterine sarcomas. Despite the low prevalence, these tumors are of great interest because of their multiple morphological and clinical features. OBJECTIVE: This article will be focused on the uterine sarcomas general aspects, etiology, prognosis, treatment and molecular features. METHOD: This review was performed using the Pubmed database to search for published articles. RESULTS: Little is known about the etiology of uterine sarcomas. Some studies have demonstrated the association between genetic events involving mutations in genes of the cell cycle and apoptosis and epigenetic in gynecologic sarcomas. Previous studies showed that chromosomal translocations have been identified, resulting in fusion genes that are constitutive and might involve the activation of transcription factors. Advances in molecular techniques have improved the diagnostic possibilities and allowed an improved understanding of the various pathologies. CONCLUSIONS: There are several factors that make the study of sarcomas a challenging issue, since those tumors are rare and the cell origin of each histologic type is nor well known Thus, molecular study of the events involved in the development of different types of cancer may lead to new strategies used in the diagnosis and treatment of these tumors.

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The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review

Abstract: Our review data fully justifies the rationale of lymphadenectomy, which beyond staging information seems to offer a measurable survival benefit.

Cited by 49 publications

References 36 publications

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study

Malignant Mixed Müllerian Tumour of the Uterus: Analysis of 44 Cases

Clinical and molecular features of uterine sarcomas

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