Uterine carcinosarcoma vs endometrial serous and clear cell carcinoma: A systematic review and meta-analysis of survival

Background It is unclear whether uterine carcinosarcoma (UCS) is more aggressive than endometrial serous carcinoma (SC) and clear cell carcinoma (CCC). Objectives To compare the prognosis of UCS to that of endometrial SC and CCC, through a systematic review and meta-analysis. Methods Four electronic databases were searched from January 2000 to October 2020. All studies assessing hazard ratio (HR) for death in UCS vs SC and/or CCC. HRs for death with 95% confidence interval were extracted and pooled by using a random-effect model. A significant P-value <0.05 was adopted. Results Six studies with 11 029 patients (4995 with UCS, 4634 with SC, 1346 with CCC and 54 with either SC or CCC) were included. UCS showed a significantly worse prognosis than SC/CCC both overall (HR = 1.51; P = 0.008) and at early stage (HR = 1.58; P < 0.001). Similar results were found for UCS vs SC (HR = 1.53; P < 0.001) and UCS vs CCC (HR = 1.60; P < 0.001). Conclusions Compared to SC and CCC, UCS has a significantly worse prognosis, with a 1.5-1.6-fold increased risk of death. This might justify a more aggressive treatment for UCS compared to SC and CCC. Further studies are necessary to define the prognostic impact of different molecular subgroups

Diagnostic accuracy of HNF1β, Napsin A and P504S/Alpha-Methylacyl-CoA Racemase (AMACR) as markers of endometrial clear cell carcinoma

Endometrial clear cell carcinoma (CCC) shows morphological overlap with endometrioid and serous carcinoma. We aimed to assess the accuracy of immunohistochemical diagnostic markers of CCC, i.e. HNF1 beta, Napsin A and P504S/Alpha-Methylacyl-CoA Racemase (AMACR). A systematic review and meta-analysis was conducted by searching 4 electronic databases from their inception to April 2022 for all studies assessing HNF1 beta, Napsin A and/or AMACR in endometrial CCC vs endometrioid/ serous carcinomas. Diagnostic accuracy was assessed as sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR) and area under the curve (AUC) on sROC curves. Eleven studies were included. HNF1 beta positivity (any expression) showed sensitivity= 0.78; specificity= 0.81; LR+ =2.46; LR-= 0.38; DOR= 5.96; AUC= 0.79. Diffuse HNF1 beta expression showed sensitivity= 0.53; specificity= 0.95; LR+ =9.68; LR-= 0.51; DOR= 18.02; AUC= 0.40. Napsin A positivity (any expression) showed sensitivity= 0.76; specificity= 0.97; LR+ =18.79; LR-= 0.27; DOR= 73.31; AUC= 0.81. Diffuse Napsin A expression showed sensitivity= 0.52; specificity= 0.99; LR+ =14.50; LR-= 0.55; DOR= 24.93; AUC= 0.98. AMACR positivity (any expression) showed sensitivity= 0.76; specificity= 0.86; LR+ =4.86; LR-= 0.30; DOR= 13.56; AUC was not assessable due to the presence of only 2 studies. In conclusion, HNF1 beta, Napsin A and AMACR show moderate accuracy in identifying endometrial CCC. Considering only a diffuse expression of these markers as positive leads to high specificity but low sensitivity. In particular, Napsin A appears as the most specific marker of endometrial CCC