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Clinicopathological determinants of survival and response to therapy in patients (pts) with gynaecological (GYN) carcinosarcomas (CS)

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ESGO State of the Art 2018 Conference

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Abstract

Introduction Carcinosarcomas (CS) are rare and aggressive GYN epithelial malignancies that contain both malignant sarcomatous and carcinomatous elements. There are no standard therapeutic options implemented. Methods Retrospective review of GYN CS uterine (UT) and ovarian (OC) pts treated at the Vall d´Hebron Hospital from 2009-2017 was conducted. Clinicopathological features and treatment modalities were correlated with outcomes. Overall Survival (OS) was calculated with Kaplan Meier method and multivariate Cox models were constructed. Results A total of 41 CS pts (UT 33 (80.5%), OC 8 (19.5%)) were selected. Median age at diagnosis was 68 years (44-91), including 15 (36.6%) stage I/II, 26 (64%) stage III/IV pts. All but one had grade 3 histology and 12 pts (30%) had heterologous (HT) component. Thirty-seven pts (90%) had surgery, 7 pts (19%) had adjuvant chemotherapy/radiotherapy (CT/RT), 7 pts (19%) RT and 9 pts (24%) CT alone. With a median follow up of 46 months (mo), 18 pts (47%) recurred with median relapse free survival (RFS) of 7.8 mo (CI95% 4.3-25.8), without significant association with clinicopathological factors or adjuvant treatment. Twelve pts (29%) received 1st line therapy (92% platinum-based) with overall response rate of 50% (17% complete response and 33% partial response). Median progression-free survival (PFS) was 11.2 mo (CI95% 6.3-not reached) and median duration of response was 22.0 mo (CI95% 7.7-not reached). We found a trend for higher median PFS in 9 pts with homologous (HM) CS compared to 3 HT-CS pts (17.0 mo vs 6.3 mo; p=0.08). Only 5 pts (42%) received a 2nd line therapy. Median OS for the entire cohort was 18.6 mo (CI95% 9.4-not reached). Multivariate model showed improved OS for OC vs. UT CS (HR=0.18; p=0.06) and HM-CS vs. HT-CS (HR=0.3; p=0.08). Conclusion GYN CS pts have poor outcomes with relapses occurring mostly in the first year after surgery. Homologous CS pts treated with first-line platinum-based CT showed improved outcomes with long-lasting responses in some pts, which reveals potential opportunities for research. Understanding the different molecular basis of GYN CS remains crucial to improve outcomes and hopefully help personalize treatment.

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