The Prognostic Factor Analysis of Malignant Mixed Müllerian Tumor; Based on Clinicopathologic Factors

ABSTRACT Background Malignant mixed mullerian tumor (MMMT) is a rare and highly aggressive malignancy with biphasic pathologic characteristics; epithelial and mesenchymal components. Until now, its prognosis is still poor and there is no individualized therapy according to the biological characteristics. The aim of this study was to analyze the clincopathological features and identify the prognostic factors which impact the survival outcome. Methods A retrospective review of patients with MMMT who treated between 1994 and 2011 in our institution was undertaken. The clinical variables such ad age, BMI, CA-125 at diagnosis, stage, extent of surgery, pathologic findings, adjuvant chemotherapy and radiation therapy were analyzed. Univariate and multivariate analysis were done. Results The study included 62 patients. The median age was 58 years (range37.8-79.6). FIGO stages I, II, III, and IV were identified in 38.7%, 4.8%, 32.3%, and 24.2% respectively. Epithelial dominant, similar, and mesenchymal dominant pathologic type were 56.3%, 16.7%, and 27.1%. Fifty nine of 62 patients had undergone hysterectomy and salpingo-oophrectomy and 43 of 62 patients had lymphadenectomy. Chemotherapy was given to 50 patients (ifosfamide + cisplatin 17, taxol/taxotere + cisplatin 17, ifosfamide mono 4, other regimens 14). The pattern of recurrence was mainly local. Median progression-free- survival after diagnosis is only 13.3months and median overall survival is 18.3months. Adjuvant chemotheray and radiation therapy had no significant survival benefit. Univariate analysis showed CA-125 at diagnosis (HR 2.39; p = 0.02), FIGO stage I, II vs III, IV (HR 4.07; p = 0.00), myometrial invasion depth (HR 0.87; p = 0.05), lymphovascular invasion(HR 2.35; p = 0.03), and lymphadenectomy (HR 0.37; p = 0.01) had an independent influence on progression free survival. In multivariate analysis, FIGO stage I, II vs III, IV (p = 0.05) and lymphadenectomy (p = 0.05) were significant. However, pathologic type and chemotherapy regimen were not associated with risk of recurrence or death. Conclusions According to this study, the comprehensive surgical staging is more important to predict the prognosis than its pathologic characteristics. Further molecular studies are needed to find out for breakthrough the poor prognosis of MMMT. Disclosure All authors have declared no conflicts of interest.