Ovary and uterus-sparing procedures for low-grade endometrial stromal sarcoma: A retrospective study of 153 cases

• Published in: Gynecologic oncology 2014-03, Vol.132 (3), p.654-660
• Main Authors: Bai, Huimin, Yang, Jiaxin, Cao, Dongyan, Huang, Huifang, Xiang, Yang, Wu, Ming, Cui, Quancai, Chen, Jie, Lang, Jinghe, Shen, Keng
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Chemotherapy, Adjuvant; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrial stromal sarcoma; ESS; Female; Fertility Preservation - methods; Hematology, Oncology and Palliative Medicine; Humans; Low grade; Middle Aged; Neoplasm Grading; Obstetrics and Gynecology; Ovary - surgery; Pregnancy; Prognosis; Radiotherapy, Adjuvant; Recurrence; Retrospective Studies; Sarcoma, Endometrial Stromal - pathology; Sarcoma, Endometrial Stromal - surgery; Treatment; Uterus - surgery; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2013.12.032

Abstract Objective To discuss the optimal treatment options for low grade endometrial stromal sarcoma (LG-ESS). Methods Medical records of consecutive patients with LG-ESS in our institute were collected. The pertinent data, including clinicopathological characteristics, treatment and prognostic information were evaluated. Results A total of 153 cases of LG-ESS were included. The 5-year relapse free survival (RFS), overall survival (OS) and survival after relapse (SAR) rates were 66.1%, 95.8% and 82.9%, respectively. Ovary-sparing procedures, positive resection-margins, and myomectomy were the independent adverse factors for relapse (P < 0.0001, = 0.0041, and = 0.0075, respectively). Post-menopause, cervical involvement, and positive lymphovascular space involvement were significantly associated with survival (P < 0.0001, = 0.0020, and = 0.0163, respectively). Distance recurrence and macroscopically residual tumors negatively affected SAR (P = 0.0137 and = 0.0004, respectively). No benefit was found for lymphadenectomy in terms of both RFS and OS (P = 0.1187 and = 0.5138, respectively). Initial ovary-sparing procedures and myomectomy had no impact on OS (P = 0.0810 and = 0.8845, respectively). Adjuvant treatment had a slightly beneficial effect both on OS and SAR. Conclusion Hysterectomy with bilateral salpingo-oophorectomy and complete resection of the macroscopic lesion should be treated as the initial and salvage mainstay treatments for LG-ESS patients. Ovary-sparing procedures could be considered for young women without cervical involvement; however, long-term follow-up should be mandatory. Myomectomy should only be conserved for young patients with a strong desire for future fertility, with fully informed consent; hysterectomy was recommended after the completion of pregnancy and delivery. However, the roles of lymphadenectomy and adjuvant treatment deserve further investigation.