Are Uterine Grade 3 Endometrioid Adenocarcinoma and Carcinosarcoma Really Clinically Similar?

  • Umran Kucukgoz GulecEmail author
  • Semra Paydas
  • Derya Gumurdulu
  • Ahmet Baris Guzel
  • Emine Kilic Bagir
  • Mehmet Ali Vardar
Original Article



The aim of this study was to compare the clinical characteristics and outcomes of the cases with uterine high-grade endometrioid adenocarcinoma (HGEAC) and uterine carcinosarcoma (UCS).


A total of 141 patients were included in this study. Of them, 61 cases had uterine HGEAC (group 1) and 80 had UCS (group 2). Both groups were compared in terms of clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival. The Kaplan–Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors.


There were no statistically significant differences between the groups with regard to age, nulliparity, menopausal status, and the main initial symptom. Both groups were similar in terms of stage, depth of myometrial invasion, and lymph node metastasis. Lymphadenectomy was performed in 74% and 91% of the cases in group 1 and group 2, respectively (p < 0.001). LVSI was found to be more frequent in group 1 (p = 0.032); however, in group 2, positive cytology was more common (p = 0.008). Chemotherapy was the main adjuvant therapy for UCS, while radiotherapy was the main adjuvant therapy for HGEAC. There was no difference between the groups in terms of disease-free survival (DFS); however, overall survival (OS) was found to be longer in group 1 (p = 0.029). Histopathologic type and LVSI were determined as independent predictive factors for OS.


UCSs are clinically more aggressive than HGEAC and should be considered as a separate group of tumors.


Endometrial cancer High-grade endometrioid adenocarcinoma Malignant mixed Mullerian tumor Overall survival Uterine carcinosarcoma 



We thank Prof. Dr. Gülşah Seydaoğlu for the statistical analysis of this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Harano K, Hirakawa A, Yunokawa M, Nakamura T, Satoh T, Nishikawa T, et al. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese gynecologic oncology group. Int J Clin Oncol. 2016;21(1):168–76.CrossRefGoogle Scholar
  2. 2.
    Berton-Rigaud D, Devouassoux-Shisheboran M, Ledermann JA, Leitao MM, Powell MA, Poveda A, et al. Gynecologic cancer inter group (GCIG) consensus review for uterine and ovarian carcinosarcoma. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S55–60.CrossRefGoogle Scholar
  3. 3.
    Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: a review of the literature. Gynecol Oncol. 2015;137(3):581–8.CrossRefGoogle Scholar
  4. 4.
    Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 2008;112(1):64–70.CrossRefGoogle Scholar
  5. 5.
    Bland AE, Stone R, Heuser C, Shu J, Jazaeri A, Shutter J, et al. A clinical and biological comparison between malignant mixed Müllerian tumors and grade 3 endometrioid endometrial carcinomas. Int J Gynecol Cancer. 2009;19(2):261–5.CrossRefGoogle Scholar
  6. 6.
    Zhu J, Wen H, Bi R, Perrone T. Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study. J Gynecol Oncol. 2016;27(2):e18.CrossRefGoogle Scholar
  7. 7.
    Gungorduk K, Ozdemir A, Ertas IE, Gokcu M, Telli E, Oge T, et al. Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas. Cancer Res Treat. 2015;47(2):282–9.CrossRefGoogle Scholar
  8. 8.
    Felix AS, Stone RA, Bowser R, Chivukula M, Edwards RP, Weissfeld JL, et al. Comparison of survival outcomes between patients with malignant mixed Mullerian tumors and high-grade endometrioid, clear cell, and papillary serous endometrial cancers. Int J Gynecol Cancer. 2011;21(5):877–84.CrossRefGoogle Scholar
  9. 9.
    Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol. 2008;111(1):82–8.CrossRefGoogle Scholar
  10. 10.
    Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Gl Jacomen. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol. 2005;98(2):274–80.CrossRefGoogle Scholar
  11. 11.
    George E, Lillemoe TJ, Twiggs LB, Perrone T. Malignant mixed Müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 1995;14(1):39–44.CrossRefGoogle Scholar
  12. 12.
    Desai NB, Kollmeier MA, Makker V, Levine DA, Abu-Rustum NR, Alektiar KM. Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma. Gynecol Oncol. 2014;135(1):49–53.CrossRefGoogle Scholar
  13. 13.
    Zhang C, Hu W, Jia N, Li Q, Hua K, Tao X, Wang L, Feng W. Uterine carcinosarcoma and high-risk endometrial carcinomas: a clinicopathological comparison. Int J Gynecol Cancer. 2015;25(4):629–36.CrossRefGoogle Scholar
  14. 14.
    Cantrell LA, Havrilesky L, Moore DT, O’Malley D, Liotta M, Secord AA, Nagel CI, Cohn DE, Fader AN, Wallace AH, Rose P, Gehrig PA. A multi-institutional cohort study of adjuvant therapy in stage I–II uterine carcinosarcoma. Gynecol Oncol. 2012;127(1):22–6.CrossRefGoogle Scholar
  15. 15.
    Sorbe B, Paulsson G, Andersson S, Steineck G. A population-based series of uterine carcinosarcomas with long-term follow-up. Acta Oncol. 2013;52(4):759–66.CrossRefGoogle Scholar
  16. 16.
    Galaal K, Al Moundhri M, Bryant A, Lopes AD, Lawrie TA. Adjuvant chemotherapy for advanced endometrial cancer. Cochrane Database Syst Rev. 2014;10:10. Scholar
  17. 17.
    Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol. 2015;94(1):98–104.CrossRefGoogle Scholar
  18. 18.
    Lorusso D, Martinelli F, Mancini M, Sarno I, Ditto A, Raspagliesi F. Carboplatin–paclitaxel versus cisplatin–ifosfamide in the treatment of uterine carcinosarcoma: a retrospective cohort study. Int J Gynecol Cancer. 2014;24(7):1256–61.CrossRefGoogle Scholar
  19. 19.
    Garg G, Shah JP, Kumar S, Bryant CS, Munkarah A, Morris RT. Ovarian and uterine carcinosarcomas: a comparative analysis of prognostic variables and survival outcomes. Int J Gynecol Cancer. 2010;20(5):888–94.CrossRefGoogle Scholar
  20. 20.
    Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Ann Oncol. 2016;27(7):1257–66.CrossRefGoogle Scholar
  21. 21.
    Matsuo K, Takazawa Y, Ross MS, Elishaev E, Yunokawa M, Sheridan TB, et al. Characterizing sarcoma dominance pattern in uterine carcinosarcoma: homologous versus heterologous element. Surg Oncol. 2018;27(3):433–40.CrossRefGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Faculty of MedicineCukurova UniversitySaricamTurkey
  2. 2.Department of Medical Oncology, Faculty of MedicineCukurova UniversityAdanaTurkey
  3. 3.Department of Pathology, Faculty of MedicineCukurova UniversityAdanaTurkey

Personalised recommendations