Skip to content

Seagle BL, Kanis M, Strohl AE, Shahabi S. Survival of women with Mullerian adenosarcoma: A National Cancer Data Base study. Gynecol Oncol. 2016;143(3):636-641. PMID 27771166

One-paragraph summary

2,205 women with adenosarcoma of uterus (n=1,884), cervix (n=229) or ovary (n=92) in NCDB 1998–2011, representing 0.43% of uterine, 0.16% of cervical and 0.04% of ovarian cancers in the extract. Nodal metastasis 36/1,176 (3.1%); distant metastasis 33/1,342 (2.5%). Independent OS detriments: distant metastasis, positive surgical margin, increased age, higher composite comorbidity, adjuvant radiotherapy. Primary site, lymph-node status, surgical procedure type, chemotherapy, race, insurance and income were not independently associated with OS. Each 1 cm of uterine-tumour size: HR 1.06 (1.01–1.12). Authors’ conclusion: complete surgical resection is the only treatment with well-evidenced OS benefit; early surgical resection may increase survival.

Key findings

  • Largest adenosarcoma dataset; the 0.43%/0.16%/0.04% shares are the only NCDB incidence-like figures.
  • Nodal disease ~3%, matching Machida SEER 2.9%.
  • Margin status, not procedure type, is the surgical OS variable.
  • Adjuvant radiotherapy associated with worse OS — confounding by indication until proven otherwise.

Limitations

  • No central pathology review; no SO, LVSI, heterologous-element, or hormone-receptor fields.
  • NCDB is hospital-based, not population-based.
  • Adjuvant-radiation OS detriment is not a causal estimate.
  • Node status not independently associated with OS here, against Machida’s CSS aHR 2.34 in SEER — a registry-to-registry discrepancy.

Why it matters

This is the scale paper. Institutional series cannot count incidence shares or 3% nodal rates. Every “surgery is the treatment” guideline sentence is more honest after this paper than before it, and every “adjuvant radiation helps” sentence is less so.

Cited by wiki pages

  • overview
  • epidemiology-and-burden
  • staging-and-prognostic-factors
  • surgical-management
  • adjuvant-and-systemic-therapy