200P - A retrospective institutional analysis on gynecological malignant mixed Mullerian tumors

Background

Malignant Mixed Mullerian Tumor (MMMT) also known as carcinosarcoma is considered as a rare aggressive biphasic tumor with carcinomatous and sarcomatous elements found in postmenopausal women, uterus being the most common site, followed by cervix, vagina, and rarely adnexa or vulva. It usually presents at an advanced stage and lacks specific treatment guidelines requiring a multimodality approach with surgery and chemoradiation (CTRT) for better prognosis & outcomes. The aim was to study the patterns of failure and overall survival in patients treated with different modalities.

Methods

An observational analysis of 82 patients from the year 2015-2019 was done including demographic data such as age and ECOG status. The patients were staged based on the FIGO 2019 system after imaging and histopathological examination. The different treatment regimens with surgery and lymph node dissection (LND), CTRT used as definitive or adjuvant therapy was noted. This study shows the impact of surgery and CTRT on overall survival (OS), progression free survival (PFS) and disease specific survival (DSS) according to stage and type of treatment. We conducted Kaplan-Meier method with log-rank tests for comparison of prognostic factors with survival and Cox proportional hazard model for both univariate and multivariate analysis considering p values <0.05 to be statistically significant. The median follow-up period was 35 months (4-76).

Results

The OS rate was 37.8% with a median of 28 months (95% CI: 22.3-33.6), a better OS was present by 34 months (95% CI: 17.18-50.81) in patients who had received adjuvant CTRT, 12 months (95% CI: 9-15) with definitive CTRT, while 7 months (95% CI: 4-10) with only surgery. There was a statistically significant improvement (p-0.001) in overall survival rate by 65.5% for those who underwent both LND with radiation. The PFS rate was 58.5% with a median of 47 months; stage I-IIIC with both surgery and CTRT had a better PFS and DSS by 64.3% and 46.4% respectively (p-0.001).

Conclusions

Patients receiving stagewise combined modality approach with both surgery and CTRT for management had a significantly better OS, PFS and DSS in comparison to with only single mode of therapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.