Clinical Characteristics and Treatment Outcomes in Ovarian Carcinosarcoma: A Retrospective Cohort Study of 90 Cases

Shihan Wan,1,2,* Li Yang,2,* Beier Wu,1,2,* Jingfang Liu,2 Yiping Jin,1,2 Jie Xing,2 Jiejie Zhang,2 Aijun Yu2 1Postgraduate Training Base Alliance of Wenzhou Medical University, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, People’s Republic of China; 2Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China*These authors contributed equally to this workCorrespondence: Aijun Yu, Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China, Email yaj1993@126.com Jiejie Zhang, Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China, Email shuibaobao198176@163.comObjective: Ovarian carcinosarcoma is a rare and highly aggressive subtype of ovarian cancer. This cohort study aimed to examine clinicopathological features, treatment patterns, and survival outcomes to enhance clinical practice and guide future research.Design: We conducted a retrospective study of 90 patients diagnosed with ovarian carcinosarcoma between 2006 and 2020.Patients and Methods: Demographic, clinical, histopathological, and treatment-related data were systematically collected and summarized. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan–Meier methods and Cox proportional hazards models.Results: The median age at diagnosis was 58 years, and 27.8% of patients had a family cancer history. Most patients were diagnosed at advanced FIGO stages III/IV (81.1%), underwent primary cytoreductive surgery (85.6%), and received adjuvant chemotherapy (95.6%, with 98.8% of these treated using platinum-based chemotherapy). During follow-up, 57.8% patients experienced their first recurrence, and 74.4% died. Multivariable survival analysis indicated that absence of a family cancer history, undergoing primary cytoreductive surgery (PCS), and receiving more than three cycles of adjuvant chemotherapy were independently associated with improved PFS. Earlier FIGO stages, primary cytoreductive, and a platinum-free interval (PFI) longer than six months were significantly associated with longer OS. Among patients with the first recurrence, undergoing secondary cytoreductive surgery (SCS) was associated with significantly improved OS.Conclusion: The retrospective study confirms the frequent late-stage diagnosis and aggressive nature of ovarian carcinosarcoma. Our findings highlight the importance of a negative family cancer history, optimal PCS, sufficient chemotherapy, prolonged PFI, and SCS in improving patient survival. This research bridges critical knowledge gaps and contributes to improving therapeutic strategies for this rare and lethal malignancy.