{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:11:05Z","timestamp":1782310265894,"version":"3.54.5"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T00:00:00Z","timestamp":1658361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic features, to recognize patterns of recurrence and to identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>This was a single institution, retrospective 10-year review of patients treated at Tygerberg Hospital in South Africa with pathologically confirmed uterine carcinosarcoma.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 61 patients were studied. Demographic, clinicopathological, treatment and outcome information were obtained. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the effects of variables on PFS and OS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Eighteen patients (29%) presented as FIGO stage I disease, 5 patients (8%) as stage II, 16 patients (26%) as stage III and 22 patients (36%) as stage IV disease. Fifty of the 61 patients (82%) had surgery. Five-year PFS and 5-year OS were 17.3% (CI 8.9%-27.9%) and 19.7% (CI 10.6%-30.8%), respectively. Seventeen patients presented with recurrence of which 5 (29.4%) were local and 12 (70.6%) were outside the pelvis.<\/jats:p>\n<jats:p>In the univariate analysis, tumour diameter \u2265 100mm (HR 4.57; 95% CI 1.59\u201313.19; p-value 0.005) was associated with 5-year PFS and in univariate analysis of OS, a positive family history (HR 0.42; 95% CI 0.18\u20130.99; p-value 0.047), receiving a full staging operation (HR 0.37; 95% CI 0.18\u20130.78; p-value 0.008) and receiving any other modality of treatment, with or without surgery, (HR 0.48; 95% CI 0.27\u20130.85; p-value 0.012) were associated with better survival. An abnormal cervical smear (HR 2.4; 95% CI 1.03\u20135.6; p-value 0.041), late-stage disease (HR 3.48; 95% CI 1.79\u20136.77; p-value &lt; 0.001), presence of residual tumour (HR 3.66; 95% CI 1.90\u20137.02; p-value &lt; 0.001), myometrial invasion more than 50% (HR 2.29; 95% CI 1.15\u20134.57; p-value 0.019), cervical involvement (HR 3.38; 95% CI 1.64\u20136.97; p-value 0.001) and adnexal involvement (HR 3.21; 95% CI 1.56\u20136.63; p-value 0.002) were associated with a higher risk of death.<\/jats:p>\n<jats:p>In the multivariate analysis, full staging operation was associated with a risk of progression of disease (HR 3.49; 95% CI 1.17\u201310.41; p-value 0.025). Advanced stage (HR 4.2; 95% CI 2.09\u20138.44; p-value &lt; 0.001) was associated with a higher risk of death. Any other modality of treatment (HR 0.28; 95% CI 0.15\u20130.53; p-value &lt; 0.001) and full staging laparotomy (HR 0.27; 95% CI 0.12\u20130.59; p-value 0.001) was a protective factor for death.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Carcinosarcoma is an aggressive cancer with poorer survival in this specific cohort than has been described in other contemporary cohorts. Biological or genetic factors are a possible explanation for lower overall survival in this population. Although it is also possible that later diagnosis and poor access to health care contribute to poorer survival. Most recurrences occur outside of the pelvis. Full staging surgery (including pelvic lymphadenectomy) and additional use of other modalities (either for radical or palliative intent) improve survival.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0271526","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T17:40:48Z","timestamp":1658425248000},"page":"e0271526","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Uterine carcinosarcoma: A 10-year single institution experience"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-2238","authenticated-orcid":true,"given":"Leana","family":"Terblanche","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthys H.","family":"Botha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,7,21]]},"reference":[{"key":"pone.0271526.ref001","first-page":"399","article-title":"The epidemiology of sarcomas of the uterus","volume":"76","author":"BL Harlow","year":"1986","journal-title":"J Natl Cancer Inst"},{"key":"pone.0271526.ref002","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1097\/IGC.0b013e31821a62dd","article-title":"Comparison of Survival Outcomes Between Patients With Malignant Mixed Mullerian Tumors and High-Grade Endometrioid, Clear Cell, and Papillary Serous Endometrial Cancers.","volume":"21","author":"AS Felix","year":"2011","journal-title":"Int J Gynecol Cancer."},{"key":"pone.0271526.ref003","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/AOG.0b013e318176157c","article-title":"Uterine Carcinosarcomas and Grade 3 endometrioid cancers: evidence for distinct tumor behavior.","volume":"112","author":"N Bansal","year":"2008","journal-title":"Obstet Gynecol."},{"key":"pone.0271526.ref004","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.3802\/jgo.2016.27.e18","article-title":"Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study","volume":"27","author":"J Zhu","year":"2016","journal-title":"J Gynecol Oncol"},{"key":"pone.0271526.ref005","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00004347-199501000-00007","article-title":"Malignant mixed m\u00fcllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival.","volume":"14","author":"E George","year":"1995","journal-title":"Int J Gynecol Pathol"},{"key":"pone.0271526.ref006","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.ygyno.2016.10.016","article-title":"Impact of histology and surgical approach on survival among women with early-stage, high-grade uterine cancer: An NRG Oncology\/Gynecologic Oncology Group ancillary analysis \u2729","volume":"143","author":"Amanda N. Fader","year":"2016","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref007","first-page":"S75","article-title":"Comparative Survival Outcomes of Uterine Papillary Serous Carcinoma, Clear Cell Carcinoma, Grade 3 Endometrioid Adenocarcinoma, and Carcinosarcoma of Endometrial Cancer in Rajavithi Hospital.","volume":"99","author":"N Prueksaritanond","year":"2016","journal-title":"J Med Assoc Thai."},{"key":"pone.0271526.ref008","first-page":"1","article-title":"Uterine carcinosarcoma vs endometrial serous and clear cell carcinoma: A systematic review and meta-analysis of survival.","author":"A Raffone","year":"2021","journal-title":"Int J Gynecol Obstet"},{"key":"pone.0271526.ref009","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s00404-010-1649-0","article-title":"The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review.","volume":"282","author":"G Vorgias","year":"2010","journal-title":"Arch Gynecol Obstet"},{"key":"pone.0271526.ref010","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/IGC.0000000000000720","article-title":"Uterine Sarcoma.","volume":"26","author":"M Hosh","year":"2016","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0271526.ref011","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1002\/cncr.2820710440","article-title":"Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study","volume":"71","author":"FJ Major","year":"1993","journal-title":"Cancer"},{"key":"pone.0271526.ref012","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/1097-0142(19860101)57:1<155::AID-CNCR2820570131>3.0.CO;2-C","article-title":"Patterns of recurrence in malignant mixed m\u00fcllerian tumor of the uterus","volume":"57","author":"WJ Spanos","year":"1986","journal-title":"Cancer"},{"key":"pone.0271526.ref013","doi-asserted-by":"crossref","first-page":"2782","DOI":"10.1002\/1097-0142(20000615)88:12<2782::AID-CNCR17>3.0.CO;2-K","article-title":"Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus","volume":"88","author":"SD Yamada","year":"2000","journal-title":"Cancer"},{"key":"pone.0271526.ref014","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/IGC.0000000000000347","article-title":"Clinical outcomes of uterine carcinosarcoma: Results of 94 patients","volume":"25","author":"ZK Gokce","year":"2015","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0271526.ref015","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1525-1438.2006.00762.x","article-title":"Early-stage carcinosarcoma of the uterus: the significance of lymph node count.","volume":"17","author":"SM Temkin","year":"2007","journal-title":"Int J Gynecol cancer"},{"key":"pone.0271526.ref016","first-page":"1","article-title":"Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma.","author":"YE \u015e\u00fck\u00fcr","year":"2017","journal-title":"Int J Clin Oncol."},{"key":"pone.0271526.ref017","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s10147-015-0859-7","article-title":"Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group","volume":"21","author":"K Harano","year":"2016","journal-title":"Int J Clin Oncol"},{"key":"pone.0271526.ref018","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1006\/gyno.1998.4941","article-title":"Evidence for a common etiology for endometrial carcinomas and malignant mixed mullerian tumors","volume":"69","author":"A Zelmanowicz","year":"1998","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref019","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/(SICI)1097-0142(19960215)77:4<717::AID-CNCR18>3.0.CO;2-3","article-title":"Exogenous sex hormone use, correlates of endogenous hormone levels, and the incidence of histologic types of sarcoma of the uterus","volume":"77","author":"SM Schwartz","year":"1996","journal-title":"Cancer"},{"key":"pone.0271526.ref020","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1046\/j.1525-1438.2000.010004280.x","article-title":"Uterine carcinosarcomas in patients receiving tamoxifen. A report of 19 cases","volume":"10","author":"WG McCluggage","year":"2000","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0271526.ref021","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1111\/j.1471-0528.1997.tb11992.x","article-title":"Uterine carcinosarcoma in association with tamoxifen therapy.","volume":"104","author":"WG McCluggage","year":"1997","journal-title":"Br J Obstet Gynaecol"},{"key":"pone.0271526.ref022","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S0301-2115(98)00166-3","article-title":"Carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer","volume":"82","author":"M Friedrich","year":"1999","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0271526.ref023","first-page":"746","article-title":"Postradiation carcinosarcoma of the corpus uteri\u2014a case report.","volume":"36","author":"A Zwierzchowska","year":"2015","journal-title":"Eur J Gynaecol Oncol"},{"key":"pone.0271526.ref024","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ygyno.2012.06.020","article-title":"A multi-institutional cohort study of adjuvant therapy in stage I-II uterine carcinosarcoma","volume":"127","author":"LA Cantrell","year":"2012","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref025","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/IGC.0b013e3181a831fb","article-title":"Patterns of failure for conservatively managed surgical stage I uterine carcinosarcoma: Implications for adjuvant therapy","volume":"19","author":"CA Leath","year":"2009","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0271526.ref026","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/0167-8140(90)90100-B","article-title":"Mixed M\u00fcllerian tumours of the uterus\u2014prognostic factors: a clinical and histopathologic study of 147 cases.","volume":"17","author":"B Larson","year":"1990","journal-title":"Radiother Oncol."},{"key":"pone.0271526.ref027","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0020-7292(82)90079-0","article-title":"Mixed Mullerian Tumors of the uterus: clinical and pathologic correlations.","volume":"20","author":"R Lotocki","year":"1982","journal-title":"Int J Gynaecol Obstet."},{"key":"pone.0271526.ref028","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.ajog.2008.04.019","article-title":"The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma.","volume":"199","author":"JD Wright","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0271526.ref029","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ygyno.2008.05.016","article-title":"Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: A SEER analysis","volume":"111","author":"D Nemani","year":"2008","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref030","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/01.coc.0000156919.04133.98","article-title":"On the apparent failure of adjuvant pelvic radiotherapy to improve survival for women with uterine sarcomas confined to the uterus.","volume":"28","author":"KE Dusenbery","year":"2005","journal-title":"Am J Clin Oncol"},{"key":"pone.0271526.ref031","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/S0360-3016(03)01561-X","article-title":"Malignant mixed m\u00fcllerian tumors of the uterus: Analysis of patterns of failure, prognostic factors, and treatment outcome","volume":"58","author":"M Callister","year":"2004","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"pone.0271526.ref032","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1053\/ejso.2000.1104","article-title":"Adjuvant pelvic radiotherapy for uterine carcinosarcoma in a high risk population.","volume":"27","author":"T. Le","year":"2001","journal-title":"Eur J Surg Oncol"},{"key":"pone.0271526.ref033","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1006\/gyno.1999.5400","article-title":"Results of primary and adjuvant radiotherapy in the treatment of mixed M\u00fcllerian tumors of the corpus uteri","volume":"73","author":"TH Knocke","year":"1999","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref034","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1006\/gyno.1998.5251","article-title":"Uterine sarcomas: the Curie Institut experience. Prognosis factors and adjuvant treatments","volume":"72","author":"L Chauveinc","year":"1999","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref035","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1006\/gyno.1997.4676","article-title":"The role of whole-pelvic irradiation in the treatment of early-stage uterine carcinosarcoma","volume":"65","author":"DS Chi","year":"1997","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref036","first-page":"541","article-title":"Postoperative pelvic irradiation in early stage uterine mixed mullerian tumors.","volume":"19","author":"KL Molpus","year":"1998","journal-title":"Eur J Gynaecol Oncol"},{"key":"pone.0271526.ref037","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1006\/gyno.1997.4901","article-title":"The impact of adjuvant radiotherapy on carcinosarcoma of the uterus","volume":"68","author":"K Gerszten","year":"1998","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref038","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ygyno.2007.07.070","article-title":"A Gynecologic Oncology Group Randomized Phase III Trial of Whole Abdominal Irradiation (WAI) vs Cisplatin-Ifosfamide and Mesna (CIM) as Post-Surgical Therapy in Stage I-IV Carcinosarcoma (CS) of the Uterus.","volume":"107","author":"AH Wolfson","year":"2007","journal-title":"Gynecol Oncol."},{"key":"pone.0271526.ref039","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1200\/JCO.2006.06.4907","article-title":"Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: A gynecologic oncology group study","volume":"25","author":"HD Homesley","year":"2007","journal-title":"J Clin Oncol"},{"key":"pone.0271526.ref040","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.ejca.2008.01.019","article-title":"Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: An European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874).","volume":"44","author":"NS Reed","year":"2008","journal-title":"Eur J Cancer"},{"key":"pone.0271526.ref041","doi-asserted-by":"crossref","first-page":"5500","DOI":"10.1200\/JCO.2019.37.15_suppl.5500","article-title":"A randomized phase 3 trial of paclitaxel (P) plus carboplatin (C) versus paclitaxel plus ifosfamide (I) in chemotherapy-naive patients with stage I-IV, persistent or recurrent carcinosarcoma of the uterus or ovary: An NRG Oncology trial.","volume":"37","author":"MA Powell","year":"2019","journal-title":"J Clin Oncol"},{"key":"pone.0271526.ref042","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ygyno.2011.10.008","article-title":"Phase II trial of adjuvant pelvic radiation \u201csandwiched\u201d between ifosfamide or ifosfamide plus cisplatin in women with uterine carcinosarcoma.","volume":"124","author":"MH Einstein","year":"2012","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref043","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/IGC.0000000000000561","article-title":"The Impact of Adjuvant Therapy on Survival and Recurrence Patterns in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study.","volume":"26","author":"DM Guttmann","year":"2016","journal-title":"Int J Gynecol cancer"},{"key":"pone.0271526.ref044","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ygyno.2015.08.014","article-title":"Patterns of care, predictors and outcomes of chemotherapy for uterine carcinosarcoma: a National Cancer Database analysis","volume":"139","author":"JA Rauh-Hain","year":"2015","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref045","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1002\/1097-0142(20010415)91:8<1437::AID-CNCR1150>3.0.CO;2-P","article-title":"Multimodality therapy for patients with clinical Stage I and II malignant mixed M\u00fcllerian tumors of the uterus","volume":"91","author":"TP Manolitsas","year":"2001","journal-title":"Cancer"},{"key":"pone.0271526.ref046","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1097\/IGC.0000000000000001","article-title":"Treatment outcomes in completely resected stage I to stage IV uterine carcinosarcoma with rhabdomyosarcoma differentiation","volume":"23","author":"V Makker","year":"2013","journal-title":"Int J Gynecol cancer"},{"key":"pone.0271526.ref047","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ygyno.2004.12.006","article-title":"A comparison between different postoperative treatment modalities of uterine carcinosarcoma","volume":"97","author":"J Menczer","year":"2005","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref048","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4143\/crt.2014.009","article-title":"Adjuvant treatment modalities, prognostic predictors and outcomes of uterine carcinosarcomas","volume":"47","author":"K Gungorduk","year":"2015","journal-title":"Cancer Res Treat"},{"key":"pone.0271526.ref049","first-page":"1","article-title":"Chemoradiation Versus Chemotherapy in Uterine Carcinosarcoma.","volume":"00","author":"B Odei","year":"2017","journal-title":"Am J Clin Oncol."},{"key":"pone.0271526.ref050","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ygyno.2015.09.002","article-title":"A multi-institutional study of outcomes in stage I\u2013III uterine carcinosarcoma","volume":"139","author":"EL Dickson","year":"2015","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref051","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1097\/IGC.0000000000001014","article-title":"Use of Adjuvant Chemotherapy, Radiation Therapy, or Combined Modality Therapy and the Impact on Survival for Uterine Carcinosarcoma Limited to the Pelvis","volume":"27","author":"AT Wong","year":"2017","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0271526.ref052","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ygyno.2017.01.010","article-title":"Stage I uterine carcinosarcoma: Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy","volume":"145","author":"BLL Seagle","year":"2017","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref053","first-page":"329","article-title":"Pathologic prognostic factors in stage I-III uterine carcinosarcoma treated with postoperative radiotherapy","volume":"290","author":"\u00c1 Rovirosa","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"pone.0271526.ref054","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1006\/gyno.1997.4827","article-title":"Carcinosarcoma of the Uterus: A Clinicopathological Multicenter CTF Study","volume":"67","author":"E Sartori","year":"1997","journal-title":"Gynecol Oncol"},{"key":"pone.0271526.ref055","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/IGC.0000000000001176","article-title":"Prognostic Significance of omental Disease and the Role of Omental Sampling in Patients With Uterine Carcinosarcoma.","volume":"28","author":"MS Ross","year":"2018","journal-title":"Int J Gynecol cancer"},{"key":"pone.0271526.ref056","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1097\/PAS.0b013e3181161ba3","article-title":"Prognostic features of surgical stage I uterine carcinosarcoma.","volume":"31","author":"SE Ferguson","year":"2007","journal-title":"Am J Surg Pathol"},{"key":"pone.0271526.ref057","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1159\/000488531","article-title":"Lymphadenectomy and Adjuvant Therapy Improve Survival with Uterine Carcinosarcoma: A Large Retrospective Cohort Study","volume":"95","author":"MAC Versluis","year":"2018","journal-title":"Oncology"},{"key":"pone.0271526.ref058","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1002\/cncr.22185","article-title":"Therapeutic role of lymph node resection in endometrioid corpus cancer: A study of 12,333 patients","volume":"107","author":"JK Chan","year":"2006","journal-title":"Cancer"},{"key":"pone.0271526.ref059","unstructured":"NCCN Clinical Practice Guidelines in Oncology. Uterine neoplasms. Version 1.2018."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T17:41:53Z","timestamp":1658425313000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271526"}},"subtitle":[],"editor":[{"given":"Sethu Thakachy","family":"Subha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,7,21]]},"references-count":59,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0271526","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,21]]}}}