Uterine carcinosarcoma: Clinicopathological features, treatment patterns and outcomes in a retrospective cohort

Background: Uterine carcinosarcoma (UCS) is a rare and highly aggressive malignancy associated with poor prognosis and a high risk of recurrence. Data from low- and middle-income countries remain limited. This study aimed to evaluate the clinicopathological characteristics, treatment patterns, and outcomes of UCS in a Moroccan tertiary care center.
Methods: We conducted a retrospective, descriptive study including patients with histologically confirmed uterine carcinosarcoma treated between January 2012 and December 2022 at the Hassan II University Hospital in Fez. Clinical, pathological, therapeutic, and follow-up data were collected. Descriptive statistical analysis was performed.
Results: A total of 21 patients were included. The mean age at diagnosis was 61 years. Most patients presented with advanced disease, with 95.2% diagnosed at FIGO stage III–IV. All patients underwent surgery, and 95.2% received external beam radiotherapy, while all patients received vaginal brachytherapy. Chemotherapy was administered using various modalities, including concomitant (71.4%), adjuvant (33.3%), and palliative (57.1%) approaches. During follow-up, distant metastases were observed in 52.4% of patients, local recurrence in 28.6%, and disease progression in 19.0%. The overall mortality rate was 61.9%.
Conclusion: Uterine carcinosarcoma remains a highly aggressive malignancy characterized by advanced-stage presentation and poor outcomes. Despite multimodal treatment, distant metastases represent the predominant pattern of failure, highlighting the need for improved systemic therapeutic strategies.