Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network
Abstract
Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Patients and Data Collection
2.2. Statistical Plan
3. Results
3.1. Patient Characteristics
3.2. Initial Treatment Characteristics and Outcome
3.3. Front-Line Management
3.4. Recurrence or Relapse Setting
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Primitive Tumor | All Patients | |||||
---|---|---|---|---|---|---|
Ovarian | Uterine | |||||
N = 112 | N = 313 | N = 425 | ||||
Primitive Tumor | ||||||
Ovarian | 112 | (100.0%) | 0 | (0.0%) | 112 | (26.4%) |
Uterine | 0 | (0.0%) | 313 | (100.0%) | 313 | (73.6%) |
Age at diagnosis | ||||||
Mean (Std) | 66.8 (10.4) | 69.1 (9.7) | 68.5 (10.0) | |||
Median (min; max) | 67.1 (25.7; 89.9) | 69.1 (29.4; 90.2) | 68.6 (25.7; 90.2) | |||
Age at diagnosis | ||||||
0–59 | 25 | (22.3%) | 50 | (16.0%) | 75 | (17.6%) |
≥60 | 87 | (77.7%) | 263 | (84.0%) | 350 | (82.4%) |
Stage | ||||||
Missing data | 6 | 5 | 11 | |||
I | 9 | (8.5%) | 140 | (45.5%) | 149 | (36.0%) |
II | 9 | (8.5%) | 28 | (9.1%) | 37 | (8.9%) |
III | 71 | (67.0%) | 98 | (31.8%) | 169 | (40.8%) |
IV | 17 | (16.0%) | 42 | (13.6%) | 59 | (14.3%) |
Detailed stage | ||||||
Missing data | 13 | 27 | 40 | |||
IA | 3 | (3.0%) | 86 | (30.1%) | 89 | (23.1%) |
IB | 1 | (1.0%) | 51 | (17.8%) | 52 | (13.5%) |
IC | 5 | (5.1%) | 2 | (0.7%) | 7 | (1.8%) |
IIA | 6 | (6.1%) | 4 | (1.4%) | 10 | (2.6%) |
IIB | 2 | (2.0%) | 5 | (1.7%) | 7 | (1.8%) |
IIC | 1 | (1.0%) | 0 | (0.0%) | 1 | (0.3%) |
IIIA | 1 | (1.0%) | 21 | (7.3%) | 22 | (5.7%) |
IIIB | 4 | (4.0%) | 9 | (3.1%) | 13 | (3.4%) |
IIIC | 59 | (59.6%) | 66 | (23.1%) | 125 | (32.5%) |
IV | 17 | (17.2%) | 42 | (14.7%) | 59 | (15.3%) |
Metastasis site * | ||||||
Missing data | 1 | 0 | 1 | |||
Liver | 7 | (43.8%) | 5 | (11.9%) | 12 | (20.7%) |
Peritoneum | 4 | (25.0%) | 10 | (23.8%) | 14 | (24.1%) |
Lung-Pleura | 5 | (31.3%) | 15 | (35.7%) | 20 | (34.5%) |
Brain | 0 | (0.0%) | 1 | (2.4%) | 1 | (1.7%) |
Extra-pelvic lymph node | 4 | (25.0%) | 5 | (11.9%) | 9 | (15.5%) |
Bone | 0 | (0.0%) | 8 | (19.0%) | 8 | (13.8%) |
Ovary | 0 | (0.0%) | 3 | (7.1%) | 3 | (5.2%) |
Rectum | 0 | (0.0%) | 5 | (11.9%) | 5 | (8.6%) |
Bowel | 0 | (0.0%) | 3 | (7.1%) | 3 | (5.2%) |
Other | 0 | (0.0%) | 5 | (11.9%) | 5 | (11.9%) |
Histological sarcomatous subtype | ||||||
Missing data | 23 | 56 | 79 | |||
Homologous | 23 | (25.8%) | 99 | (38.5%) | 122 | (35.3%) |
Heterologous | 66 | (74.2%) | 158 | (61.5%) | 224 | (64.7%) |
Histological epithelial subtype | ||||||
Missing data | 36 | 105 | 141 | |||
Serous | 50 | (65.8%) | 77 | (37.0%) | 127 | (44.7%) |
Endometrioid | 8 | (10.5%) | 99 | (47.6%) | 107 | (37.7%) |
Other | 18 | (23.7%) | 32 | (15.4%) | 50 | (17.6%) |
Majority component | ||||||
Missing data | 55 | 103 | 158 | |||
Epithelial | 38 | (66.7%) | 109 | (51.9%) | 147 | (55.1%) |
Sarcomatous | 19 | (33.3%) | 99 | (47.1%) | 118 | (44.2%) |
Prior cancer | ||||||
Unknown | 2 | 6 | 8 | |||
Yes | 26 | (23.6%) | 68 | (22.1%) | 94 | (22.5%) |
No | 84 | (76.4%) | 239 | (77.9%) | 323 | (77.5%) |
Cancer type * | ||||||
Breast | 15 | (57.7%) | 49 | (72.1%) | 64 | (68.1%) |
Uterine corpus | 1 | (3.8%) | 0 | (0.0%) | 1 | (1.1%) |
Uterine cervix | 2 | (7.7%) | 0 | (0.0%) | 2 | (2.1%) |
Lung | 0 | (0.0%) | 2 | (2.9%) | 2 | (2.1%) |
Colon | 1 | (3.8%) | 1 | (1.5%) | 2 | (2.1%) |
Rectum | 0 | (0.0%) | 4 | (5.9%) | 4 | (4.3%) |
Canal anal | 1 | (3.8%) | 5 | (7.4%) | 6 | (6.4%) |
Hematologic | 1 | (3.8%) | 3 | (4.4%) | 4 | (4.3%) |
Other | 5 | (19.2%) | 7 | (10.3%) | 12 | (12.8%) |
Previous Tamoxifen exposure | ||||||
Unknown | 4 | 14 | 18 | |||
Yes | 2 | (1.9%) | 20 | (6.7%) | 22 | (5.4%) |
No | 106 | (98.1%) | 279 | (93.3%) | 385 | (94.6%) |
History of pelvic radiotherapy | ||||||
Unknown | 2 | 7 | 9 | |||
Yes | 1 | (0.9%) | 11 | (3.6%) | 12 | (2.9%) |
No | 109 | (99.1%) | 295 | (96.4%) | 404 | (97.1%) |
Menopausal hormone therapy exposure | ||||||
Unknown | 43 | 83 | 126 | |||
Yes | 15 | (21.7%) | 37 | (16.1%) | 52 | (17.4%) |
No | 54 | (78.3%) | 193 | (83.9%) | 247 | (82.6%) |
BRCA status | ||||||
Unknown | 72 | 300 | 372 | |||
BRCAwt | 36 | (90.0%) | 12 | (92.3%) | 48 | (90.6%) |
BRCA1 | 1 | (2.5%) | 1 | (7.7%) | 2 | (3.8%) |
BRCA2 | 3 | (7.5%) | 0 | (0.0%) | 3 | (5.7%) |
Family history of cancer | ||||||
Missing data | 21 | 68 | 89 | |||
No | 34 | (37.4%) | 132 | (53.9%) | 166 | (49.4%) |
Yes | 57 | (62.6%) | 113 | (46.1%) | 170 | (50.6%) |
Cancer type * | ||||||
Breast cancer | 25 | (27.5%) | 45 | (18.4%) | 70 | (20.8%) |
Endometrial cancer | 10 | (11.0%) | 16 | (6.5%) | 26 | (7.7%) |
Ovarian cancer | 5 | (5.5%) | 7 | (2.9%) | 12 | (3.6%) |
Colorectal cancer | 8 | (8.8%) | 19 | (7.8%) | 27 | (8.0%) |
Pancreatic cancer | 3 | (3.3%) | 11 | (4.5%) | 14 | (4.2%) |
Prostate cancer | 8 | (8.8%) | 9 | (3.7%) | 17 | (5.1%) |
Gastric cancer | 1 | (1.1%) | 1 | (0.4%) | 2 | (0.6%) |
Brain cancer | 2 | (2.2%) | 7 | (2.9%) | 9 | (2.7%) |
Cutaneous cancer | 2 | (2.2%) | 1 | (0.4%) | 3 | (0.9%) |
Other | 26 | (28.6%) | 64 | (26.1%) | 90 | (26.8%) |
Event/Total | Median (95% CI) KM | Hazard Ratio (95% CI) Cox | Survival Estimates (95% CI) KM | p-Value | |
---|---|---|---|---|---|
Stage | 0.0325 * | ||||
I–IIA | 8/15 | 24.8 (10.4–NE) | Reference | 12 months: 0.73 (0.44–0.89) | |
24 months: 0.52 (0.25–0.74) | |||||
36 months: 0.44 (0.19–0.67) | |||||
IIB–IV | 63/81 | 12.9 (8.4–19.8) | 2.19 (1.05–4.58) | 12 months: 0.53 (0.41–0.63) | |
24 months: 0.32 (0.22–0.43) | |||||
36 months: 0.19 (0.11–0.30) |
Event/Total | Median (95% CI) KM | Hazard Ratio (95% CI) Cox | Survival Estimates (95% CI) KM | p-Value | |
---|---|---|---|---|---|
Stage | <0.0001 * | ||||
I | 80/139 | 22.2 (14.9–32.4) | Reference | 12 months: 0.70 (0.62–0.77) | |
24 months: 0.47 (0.38–0.55) | |||||
36 months: 0.41 (0.32–0.50) | |||||
II | 23/28 | 15.1 (8.8–18.3) | 1.62 (1.02–2.58) | 12 months: 0.61 (0.40–0.76) | |
24 months: 0.25 (0.11–0.42) | |||||
36 months: 0.21 (0.09–0.38) | |||||
III | 68/96 | 14.8 (11.7–18.7) | 1.43 (1.03–1.97) | 12 months: 0.60 (0.49–0.69) | |
24 months: 0.31 (0.22–0.41) | |||||
36 months: 0.27 (0.18–0.37) | |||||
IV | 33/35 | 7.3 (5.5–9.4) | 4.24 (2.79–6.44) | 12 months: 0.12 (0.04–0.25) | |
24 months: 0.06 (0.01–0.18) | |||||
36 months: 0.03 (0.00–0.13) |
Event/Total | Median (95% CI) KM | Hazard Ratio (95% CI) Cox | p-Value | |
---|---|---|---|---|
Adjuvant strategy | <0.0001 * | |||
No adj | 19/20 | 6.5 (2.3–13.5) | Reference | |
CT alone | 5/7 | 13.1 (3.1–22.2) | 0.54 (0.20–1.45) | |
RT alone | 53/89 | 21.0 (14.0–42.6) | 0.26 (0.15–0.44) | |
Concomitant CT + RT | 5/7 | 18.3 (2.9–NE) | 0.34 (0.13–0.93) | |
CT then RT | 19/41 | 41.0 (17.0–NE) | 0.15 (0.08–0.29) |
Event/Total | Median (95% CI) KM | Hazard Ratio (95% CI) Cox | p-Value | |
---|---|---|---|---|
Adjuvant strategy | <0.0001 * | |||
No adj | 11/14 | 3.7 (2.3–5.5) | Reference | |
CT alone | 33/37 | 9.4 (5.5–13.5) | 0.61 (0.30–1.21) | |
RT alone | 8/12 | 10.0 (7.4–NE) | 0.33 (0.13–0.84) | |
Concomitant CT + RT | 4/4 | 17.4 (6.4–26.1) | 0.45 (0.14–1.42) | |
CT then RT | 29/47 | 18.9 (14.0–45.6) | 0.24 (0.12–0.48) |
Progression-Free Survival | ||||
---|---|---|---|---|
Univariate Analysis | Multivariate Analysis | |||
Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | |
Age (<60 * vs. ≥60 yr) | 1.292 (0.88–1.90) | 0.1949 | ||
Stage (II vs. I *) | 1.622 (1.02–2.58) | <0.0001 | 1.595 (1.002–2.537) | 0.0024 |
Stage (III vs. I *) | 1.427 (1.03–1.97) | 1.087 (0.773–1.529) | ||
Stage (IV vs. I *) | 4.237 (2.79–6.44) | 2.204 (1.377–3.527) | ||
Initial chemotherapy (yes vs. no *) | 0.907 (0.69–1.19) | 0.4813 | ||
Initial surgery (yes vs. no *) | 0.277 (0.17–0.45) | <0.0001 | NS | |
Initial radiotherapy (yes vs. no *) | 0.300 (0.23–0.40) | <0.0001 | 0.357 (0.257–0.496) | <0.0001 |
Progression-Free Survival | ||||
---|---|---|---|---|
Univariate Analysis | Multivariate Analysis | |||
Hazard Ratio (95% CI) | p-Value | Hazard Ratio (95% CI) | p-Value | |
Age (<60 * vs. ≥ 60yr) | 1.750 (0.99–3.10) | 0.0550 | NS | |
Stage (I–IIA * vs. IIB–IV) | 2.189 (1.05–4.58) | 0.0374 | NS | |
Initial chemotherapy (yes vs. no *) | 0.205 (0.07–0.58) | 0.0027 | 0.147 (0.034–0.635) | 0.0103 |
Initial surgery (yes with CC0 vs. no *) | 0.193 (0.09–0.39) | <0.0001 | 0.179 (0.087–0.368) | <0.0001 |
Initial surgery (yes with CC1,2,3 vs. no *) | 0.667 (0.31–1.42) | 0.664 (0.312–1.413) | ||
Concomitant antiangiogenic (yes vs. no) | 0.944(0.57–1.55) | 0.8208 |
N | Complete Response | Partial Response | Stable Disease | Progressive Disease | Unknown | ORR | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Platinum/paclitaxel-based | 62 | 14 | (26.4%) | 18 | (34%) | 10 | (18.9%) | 11 | (20.8%) | 9 | 60.4% |
Platinum/anthracycline-based | 27 | 3 | (12.0%) | 9 | (36.0%) | 5 | (20.0%) | 8 | (32.0%) | 2 | 48.0% |
Platinum-free anthracycline-containing combination | 17 | 1 | (6.7%) | 6 | (40.0%) | 3 | (20.0%) | 5 | (33.3%) | 2 | 46.7% |
Platinum/gemcitabine-based | 8 | 0 | (0.0%) | 3 | (42.9%) | 2 | (28.6%) | 2 | (28.6%) | 1 | 42.9% |
Platinum monotherapy | 13 | 1 | (9.1%) | 3 | (27.3%) | 2 | (18.2%) | 5 | (45.5%) | 2 | 36.4% |
Anthracycline monotherapy | 40 | 2 | (6.1%) | 4 | (12.1%) | 3 | (9.1%) | 24 | (72.7%) | 7 | 18.2% |
Platinum- and anthracycline-free monotherapy | 18 | 0 | (0.0%) | 0 | (0.0%) | 3 | (23.1%) | 10 | (76.9%) | 5 | 0.0% |
Innovative therapy | 9 | 0 | (0.0%) | 5 | (62.5%) | 0 | (0.0%) | 3 | (37.5%) | 1 | 62.5% |
Event/Total | Median (95% CI) KM | Survival Estimates (95% CI) KM | p-Value | |
---|---|---|---|---|
<0.0001 * | ||||
Innovative therapy | 9/9 | 8.0 (0.8–10.8) | 12 months: 0.11 (0.01–0.39) | |
Platinum/anthracycline-based | 26/27 | 8.0 (4.7–10.8) | 12 months: 0.29 (0.13–0.46) | |
Platinum/paclitaxel-based | 49/56 | 6.8 (4.9–12.0) | 12 months: 0.36 (0.24–0.49) | |
Platinum/gemcitabine-based | 7/8 | 4.7 (1.2–17.6) | 12 months: 0.25 (0.04–0.56) | |
Platinum-free anthracycline-containing combination | 16/17 | 3.0 (1.2–6.7) | 12 months: 0.12 (0.02–0.31) | |
Platinum monotherapy | 9/12 | 2.9 (1.3–14.0) | 12 months: 0.23 (0.04–0.52) | |
Platinum- and anthracycline-free monotherapy | 17/17 | 2.2 (1.4–4.3) | 12 months: 0.06 (0.00–0.24) | |
Anthracycline monotherapy | 39/39 | 2.0 (1.7–2.9) | 12 months: 0.08 (0.02–0.19) |
Event/Total | Median (95% CI) KM | p-Value | |
---|---|---|---|
0.0178 * | |||
Platinum/paclitaxel-based | 11/11 | 8.1 (1.6–10.6) | |
Anthracycline-free combination | 5/6 | 5.6 (2.3–16.3) | |
Anthracycline-containing combination | 11/12 | 3.0 (0.5–5.5) | |
Other | 16/17 | 2.9 (1.5–10.3) | |
Gemcitabine monotherapy | 8/9 | 2.6 (0.8–3.5) | |
Anthracycline monotherapy | 17/19 | 2.1 (1.3–3.3) | |
Taxane monotherpy | 10/10 | 1.9 (0.3–4.8) | |
Innovative therapy | 10/10 | 1.3 (0.4–2.7) |
N | Complete Response | Partial Response | Stable Disease | Progressive Disease | Unknown | ORR | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Platinum/paclitaxel-based | 14 | 2 | (20.0%) | 6 | (60%) | 0 | (0.0%) | 2 | (20.0%) | 4 | 80% |
Anthracycline-free combination | 8 | 0 | (0.0%) | 4 | (57.1%) | 1 | (14.3%) | 2 | (28.6%) | 1 | 57.1% |
Anthracycline-containing combination | 12 | 1 | (10.0%) | 1 | (10.0%) | 4 | (40.0%) | 4 | (40.0%) | 2 | 20.0% |
Anthracycline monotherapy | 21 | 0 | (0.0%) | 1 | (5.9%) | 3 | (17.6%) | 13 | (76.5%) | 4 | 5.9% |
Taxane monotherapy | 10 | 0 | (0.0%) | 0 | (0.0%) | 3 | (33.3%) | 6 | (66.7%) | 1 | 0.0% |
Gemcitabine monotherapy | 10 | 0 | (0.0%) | 0 | (0.0%) | 0 | (0.0%) | 8 | (100.0%) | 2 | 0.0% |
Other | 18 | 0 | (0.0%) | 1 | (7.1%) | 4 | (28.6%) | 9 | (64.3%) | 4 | 7.1% |
Innovative therapy | 12 | 0 | (0.0%) | 0 | (0.0%) | 3 | (27.3%) | 8 | (72.7%) | 1 | 0.0% |
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Romeo, C.; Le Saux, O.; Jacobs, M.; Joly, F.; Ferron, G.; Favier, L.; Fumet, J.-D.; Isambert, N.; Colombo, P.-E.; Sabatier, R.; et al. Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network. Cancers 2022, 14, 354. https://doi.org/10.3390/cancers14020354
Romeo C, Le Saux O, Jacobs M, Joly F, Ferron G, Favier L, Fumet J-D, Isambert N, Colombo P-E, Sabatier R, et al. Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network. Cancers. 2022; 14(2):354. https://doi.org/10.3390/cancers14020354
Chicago/Turabian StyleRomeo, Clémence, Olivia Le Saux, Margaux Jacobs, Florence Joly, Gwenael Ferron, Laure Favier, Jean-David Fumet, Nicolas Isambert, Pierre-Emmanuel Colombo, Renaud Sabatier, and et al. 2022. "Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network" Cancers 14, no. 2: 354. https://doi.org/10.3390/cancers14020354
APA StyleRomeo, C., Le Saux, O., Jacobs, M., Joly, F., Ferron, G., Favier, L., Fumet, J.-D., Isambert, N., Colombo, P.-E., Sabatier, R., Bastide, L., Charreton, A., Devouassoux-Shisheboran, M., Gertych, W., Dubot, C., Bello Roufai, D., Bataillon, G., Berton, D., Kalbacher, E., ... Ray-Coquard, I. (2022). Therapeutic Challenges in Patients with Gynecologic Carcinosarcomas: Analysis of a Multicenter National Cohort Study from the French Prospective TMRG Network. Cancers, 14(2), 354. https://doi.org/10.3390/cancers14020354