Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients

Cancer. 1998 Feb 1;82(3):512-9.


Background: Carcinosarcoma (malignant mixed mullerian tumor) of the female genital tract is a highly malignant neoplasm. The tumor stage and histologic grade of the carcinomatous component are among the important prognostic indicators cited in the literature for this tumor.

Methods: Twenty-five patients with uterine carcinosarcoma at 4 hospitals in the Kyoto and Nara areas of Japan were studied retrospectively. The clinicopathologic and immunohistochemical data including p53, bcl-2, Ki-67, and proliferating cell nuclear antigen (PCNA) staining were analyzed using univariate and multivariate analysis with the Cox proportional hazards model to investigate potential prognostic indicators for this neoplasm.

Results: The 5-year survival rate was 36.4% for all stages, 62.3% for Stage I, and 0% for Stages II-IV. From the univariate analysis, stage (P = 0.0001), endometrioid adenocarcinoma as a carcinomatous component (P = 0.0006), age (P = 0.0355), and a heterologous sarcomatous component (P = 0.0421) were found to be prognostically significant for patient survival. Stage was the only independent significant factor in the multivariate analysis (t = 2.212). None of the other factors (history of pregnancy and gestation, gross appearance of the tumors, grade of the carcinomatous component, mitotic count of the sarcomatous component, Ki-67 and PCNA reactivity, or p53 or bcl-2 positive staining) was found to be a significant prognostic indicator.

Conclusions: Stage appears to be the only definite independent prognostic indicator of survival in patients with uterine carcinosarcoma. It is uncertain whether age, endometrioid adenocarcinoma as a carcinomatous component, or absence of a heterologous component in the sarcomatous area are prognostic factors. Immunohistochemical expression of p53, bcl-2, Ki-67, or PCNA is not a prognostic indicator. The immunohistochemical results of the current study may support the hypothesis of a common stem cell origin of this tumor.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinosarcoma / chemistry
  • Carcinosarcoma / mortality
  • Carcinosarcoma / pathology*
  • Female
  • Humans
  • Immunohistochemistry
  • Ki-67 Antigen / analysis
  • Middle Aged
  • Mixed Tumor, Mullerian / chemistry
  • Mixed Tumor, Mullerian / mortality
  • Mixed Tumor, Mullerian / pathology
  • Prognosis
  • Proliferating Cell Nuclear Antigen / analysis
  • Proto-Oncogene Proteins c-bcl-2 / analysis
  • Retrospective Studies
  • Survival Rate
  • Tumor Suppressor Protein p53 / analysis
  • Uterine Neoplasms / chemistry
  • Uterine Neoplasms / mortality
  • Uterine Neoplasms / pathology*


  • Ki-67 Antigen
  • Proliferating Cell Nuclear Antigen
  • Proto-Oncogene Proteins c-bcl-2
  • Tumor Suppressor Protein p53