Objective: Ovarian carcinosarcoma is a rare and highly aggressive biphasic neoplasm, accounting for less than 1% of ovarian malignancies. This study utilizes the National Cancer Database (NCDB) to examine the impact of demographics, clinical presentation, and treatment on the overall survival of patients diagnosed with ovarian carcinosarcoma. Methods: A cohort of 420 patients diagnosed with ovarian carcinosarcoma was identified in the NCDB from 2004 to 2020. Patient characteristics and management strategies were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariable Cox proportional hazard models to determine significance. Results: Advanced cancer stage was associated with increased mortality risk, as all stage comparisons yielded significant results, ranging from a nearly two-fold increase in risk comparing Stage I and Stage II cancers (HR: 1.96; 95% CI: 1.13 − 3.40; p = 0.017) to over a four-fold increase in Stage I vs. Stage IV hazard ratios (HR: 4.27; 95% CI: 2.64−6.90; p < 0.001). Likewise, increasing Charlson-Deyo comorbidity scores exhibited a trend towards higher mortality, although only the comparison of score 0 to scores ≥ 3 was statistically significant (HR: 6.70; 95% CI: 2.06−21.80; p = 0.002). Furthermore, only select comparisons within different income classes and educational attainment reached statistical significance. Treatment modalities were found to have inconsistent impacts on survival, as primary radiation therapy was associated with unfavorable survival outcomes (HR: 1.54; 95% CI: 1.00−2.37; p = 0.049), while chemotherapy significantly improved outcomes (HR: 0.40; 95% CI: 0.31−0.52; p < 0.001). When analyzed independently, surgical resection was not significantly associated with overall survival (HR: 0.95; 95% CI: 0.51−1.81; p = 0.887). Conclusion: Tumor staging, comorbidities, and certain treatment modalities were found to be significant predictive factors of ovarian carcinosarcoma survival. Comparisons between age, race, and insurance status were not significantly associated with overall survival.

Background: Seminoma is a malignant germ cell tumor that most commonly involves the testicles but may involve the mediastinum, the retroperitoneum, and other extra-gonadal sites as well. This study aims to investigate the somatic genomic landscape of seminoma. Methods: Data for a retrospective observational analysis of seminoma was acquired from the American Association for Cancer Research (AACR) Project Genomics Evidence Neoplasia Information Exchange (GENIE) with clinical and genomic data from 2017 and beyond. Using the R and R Studio software (R 4.5.0), analyses for common somatic mutations and copy number alterations were run with a statistical significance of p < 0.05. Results: The most mutated genes included KIT (22.6%), KRAS (17.1%), and MTOR (5.1%), with significant copy number alterations in CDKN1B (17.2%), KRAS (14.7%), CCND2 (10.3%), and H3F3C (9.8%). These suggest involvement within the KIT/RAS/MAPK and PI3K/AKT/mTOR (PAM) pathways for seminoma development. A novel finding within comparative evaluation of PMS1 and AMER1 mutations were found in Black individuals. Additionally, our findings were consistent with a lower testicular cancer rate among individuals with African ancestry than European ancestry. BRD4 mutations were found only in metastatic samples while KMT2C, STAG2, ALK, AXL, and EGFR were only found in primary samples, suggesting a possible association. Conclusions: This study provided a comprehensive molecular and genetic profiling of seminoma including key genetic alterations, affected pathways, and potential therapeutic strategies. Moreover, overlap between pathways and gene mutations provides the potential for alternative treatment options for seminoma via multiple pathways.