The purpose of this study is to investigate the effect of CD47 expression levels on survival function and to determine the relationship between the clinicopathological features of uterine carcinosarcoma (UCs).

The expression of CD47 was analyzed by calculating immunoreactivity scoring (IRS) which takes into account both the category of staining intensity (0: no immunostaining; 1: weak staining; 2: moderate staining; and 3: strong staining) as well as the grade of percentage of positive cells five grades ( 0 for 0%; 1 for 1–10%; 2 for 11–50%; 3, for 51–80%; and 4 for > 80%) via anti-CD47 antibodies by immunohistochemistry (IHC) in a total of 42 surgically resected tissue samples of patients with UCs. The staining intensity and percentage of positive cells were multiplied to obtain an IRS in the range of 0–12 for each case. If a case had an IRS score over 6, it is labelled as positive CD47 or vice versa. Patients’ clinicopathological parameters and survival data were documented from patient records. The survival function of patients was analyzed using Kaplan-Meier and Cox regression in univariate and multivariate analyses, respectively.

The median follow-up time was 39 (IQR = 18-74.25) and 34.50 (IQR = 14.5-73.75) months for overall survival (OS). CD47 positivity was detected in 26 of 42 (61.9%) resected UCs tissues. CD47 positivity did not have a significant effect on OS [HR = 1.03; 95% CI 0.328–3.240, p = 0.95]. Presence of relapse [HR = 5.24; 95% CI, 1.25–21.89 ,p = 0.023] and myometrial invasion being more than half [HR = 4.31; 95%CI1.16-15.94, p = 0.028] negatively affected OS, while adjuvant chemotherapy [HR = 0.16; 95% CI 0.039–0.661, p = 0.011] and radiotherapy [HR = 0.130, 95% CI 0.045–0.376, p < 0.001] had a positive effect on OS. When considering the disease-free survival (DFS), the same variables showed the same level of significance on DFS (p < 0.05).

This study is the first to explore the potential impact of CD47 expression on survival in patients with uterine carcinosarcoma. Although CD47 status was not a significant predictor of OS or DFS, relapse, myometrial invasion, and adjuvant therapies were identified as significant survival predictors. Given the limited sample size, these findings should be interpreted with caution, and further studies with larger cohorts are warranted to clarify the potential clinical relevance of CD47 in patients with UCs. To our knowledge, this is among the few studies to investigate CD47 expression in uterine carcinosarcoma, providing preliminary evidence for its association with tumor aggressiveness.