Journal article
Improved overall survival with combined adjuvant chemotherapy and radiation in stage I uterine carcinosarcoma: A national cancer database study
European journal of obstetrics & gynecology and reproductive biology, Vol.327(December 2026), 115448
09/19/2026
DOI: 10.1016/j.ejogrb.2026.115448
PMID: 42777469
Abstract
•Limited data exists to guide adjuvant treatment in stage I uterine carcinosarcoma.•Chemotherapy and radiation are associated with improved OS in stage I uterine carcinosarcoma.•VBT showed superior survival compared to EBRT within combined therapy.•Black race, older age, and presence of LVSI are associated with worse OS in stage I uterine carcinosarcoma.
Uterine carcinosarcomas are a rare and aggressive cancer compressing less than 5 % of all uterine malignancies. Most patients present with early-stage disease. Given the rarity of the disease, prospective, randomized data is lacking, and treatment is informed largely by small retrospective studies.
This objective of this study is to provide greater insight into appropriate adjuvant therapies in patients with uterine confined carcinosarcoma.
Retrospective cohort study of patients with stage I uterine carcinosarcoma identified through the National Cancer Database (NCDB). Data was analyzed for patients receiving no adjuvant treatment, chemotherapy alone, radiation alone, or chemotherapy and radiation. Kaplan-Meier survival analysis and Cox proportional hazards modeling, adjusted for confounding variables, were used to evaluate overall survival (OS).
Among all Stage I patients (n = 7,086), the chemotherapy and radiation group demonstrated improvement in overall survival, with Inverse Probability of Treatment Weighting hazard ratio for chemotherapy and radiation versus chemotherapy alone 0.72 (95 % CI 0.65–0.80, p < 0.0001). Within the chemotherapy and radiation group, patients receiving vaginal brachytherapy showed the greater survival benefit compared to external beam radiation therapy with an adjusted hazard ratio 0.68 (95 % CI 0.597–0.766, p < 0.0001). The benefit persisted in both stage IA and IB subgroups.
Combined chemotherapy and radiation therapy is associated with significantly improved overall survival. This benefit persists after adjusting for key covariates. Vaginal brachytherapy was associated with the greatest survival advantage among radiation modalities. These findings support combined modality treatment in managing early-stage uterine carcinosarcoma.
Details
- Title: Subtitle
- Improved overall survival with combined adjuvant chemotherapy and radiation in stage I uterine carcinosarcoma: A national cancer database study
- Creators
- Andrew Polio - University of Iowa Hospitals and ClinicsAdrienne Esposito - University of Iowa Hospitals and ClinicsJesus Gonzalez Bosquet - University of Iowa, Obstetrics and GynecologyMichael J. Goodheart - University of IowaVincent M. Wagner - University of Iowa
- Resource Type
- Journal article
- Publication Details
- European journal of obstetrics & gynecology and reproductive biology, Vol.327(December 2026), 115448
- DOI
- 10.1016/j.ejogrb.2026.115448
- PMID
- 42777469
- NLM abbreviation
- Eur J Obstet Gynecol Reprod Biol
- ISSN
- 0301-2115
- eISSN
- 1872-7654
- Publisher
- Elsevier B.V
- Language
- English
- Date published
- 09/19/2026
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9985236417302771
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