RESUMO
Uterine carcinosarcoma is a rare and aggressive tumor with poor outcomes. Cancer antigen 125 is routinely used to track the disease course of ovarian cancer and has been suggested as a biomarker in other aggressive forms of uterine cancer. We sought to characterize cancer antigen 125 as a potential biomarker of disease status in uterine carcinosarcoma. Clinical and pathological data were abstracted for patients who had surgical staging for a pathologically confirmed uterine carcinosarcoma at our institution from January 2000 to March 2014. Non-parametric tests were used to compare changes in cancer antigen 125. Elevated cancer antigen 125 (>35 U/mL) as a predictor of survival was assessed via Kaplan-Meier curves. Among the 153 patients identified, 66 patients had at least one paired measure of cancer antigen 125 drawn preoperatively, post-treatment, or at the time of disease recurrence, and 19 patients had cancer antigen-125 levels at all three time points. Analysis of the 51 patients with both preoperative and post-treatment values found a significant drop in cancer antigen 125 (p < 0.001). Among the 30 patients who had end-of-treatment and recurrence levels, a significant increase was noted (p = 0.001). There was no significant difference in cancer antigen-125 levels preoperatively compared to at recurrence among the 23 patients with levels at both time-points (p = 0.99). Elevated preoperative cancer antigen 125 was not associated with overall survival (p = 0.12); elevated post-treatment cancer antigen 125 was associated with a worse overall survival (p < 0.001). Based on this dataset, there seems to be utility in trending a cancer antigen-125 level in patients with uterine carcinosarcoma. A cancer antigen-125 level could predict recurrence and provide prognostic information regarding survival.
RESUMO
OBJECTIVES: Uterine carcinosarcomas are an aggressive and rare form of endometrial cancer. Omentectomy is not part of routine staging, but biopsy is often done because omental disease is a known poor prognostic indicator. We sought to define the role of routine omental sampling during surgical staging. METHODS/MATERIALS: Patients who underwent staging for uterine carcinosarcoma at our institution from January 2000 to December 2013 were identified. Clinical and pathological data were abstracted. Univariate and multivariable Cox proportional hazard regression analysis was used to identify significant predictors of progression-free (PFS) and overall survival (OS). Logistic regression was used to identify predictors of omental disease. RESULTS: We identified 153 patients. The median age was 65 years (range, 40-87 years), and 88.9% were Caucasian. Omental sampling was performed in 106 (69.3%) patients. Of these, 17(16%) had pathologically confirmed omental disease, and 6 (35.3%) with microscopic disease. On multivariable analysis, tumor size (P = 0.024) and postoperative radiation (P = 0.041) were significant predictors of progression-free survival, and omental disease (P = 0.002), residual disease (P = 0.03), and tumor size (P = 0.025) were significant predictors of OS. Median OS was 11.4 versus 128.7 months for those who did and did not have omental disease, respectively (P <0.001). The median OS for those who had omental sampling (127.7 months) versus those who did not (71.3 months) was not significantly different (P = 0.7432). CONCLUSIONS: Although survival was not significantly different between those who did and did not have omental sampling, omental disease had a significant impact on survival. Of those with omental disease, 35% had microscopic disease that could be missed if routine biopsy is not performed, suggesting a role for routine omental sampling.
