The role of pelvic and/or para-aortic lymphadenectomy in surgical management of apparently early carcinosarcoma of uterus.

AIMS: To determine the incidence of lymph node (LN) metastasis in patients with apparently early carcinosarcoma of the uterus, to analyze the clinicopathologic factors associated with LN metastasis, and to evaluate the role of pelvic and/or para-aortic lymphadenectomy in treatment of such conditions.

METHODS: We retrospectively analyzed 41 patients with carcinosarcoma intraoperatively confined to the uterus who underwent complete staging procedures including pelvic and/or para-aortic lymphadenectomy.

RESULTS: After surgery, two patients (4.9%) were upstaged to stage IIIA because of positive peritoneal washing cytology, and 13 (31.7%) were upstaged to stage IIIC as a result of LN metastasis. Five patients had pelvic, three had paraaortic, and five had both pelvic and para-aortic LN metastases. The mean number of metastatic LNs was 3.7 (range 1-15). On multivariate analysis, myometrial invasion >1/2 [odds ratio (OR) 8.50; 95% confidence interval (CI) 1.57-45.92; P = 0.013] and lymphovascular space invasion (LVSI) (OR 8.50; 95% CI 1.57-45.92; P = 0.013) were significantly predictive of LN metastasis. After a median follow-up interval of 32 months (range 3-179 months), the 2-year disease-free survival (DFS) and overall survival (OS) rates were 73% and 84%, respectively, and the 5-year DFS and OS rates were 73% and 69%, respectively. Patients with LVSI or LN metastasis had significantly poorer DFS and OS.

CONCLUSIONS: Pelvic and para-aortic lymphadenectomy should be performed in patients with apparently early carcinosarcoma of the uterus, especially in those with myometrial invasion >1/2 or LVSI.