Endometrial stromal sarcoma: a population-based analysis

Abstract

To determine independent prognostic factors for the survival of patients with endometrial stromal sarcoma (ESS), data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute from 1988 to 2003. Kaplan -Meier and Cox proportional hazards models were used for analyses. Of 831 women diagnosed with ESS, the median age was 52 years (range: 17 -96 years). In total, 59.9% had stage I, 5.1% stage II, 14.9% stage III, and 20.1% had stage IV disease. Overall, 13.0, 36.1, and 34.7% presented with grades 1, 2, and 3, respectively. Patients with stage I-II vs III-IV disease had 5 years DSS of 89.3% vs 50.3% (Po0.001) and those with grades 1, 2, and 3 cancers had survivals of 91.4, 95.4, and 42.1% (Po0.001). In multivariate analysis, older patients, black race, advanced stage, higher grade, lack of primary surgery, and nodal metastasis were independent prognostic factors for poorer survival. In younger women (o50 years) with stage I -II disease, ovarian-sparing procedures did not adversely impact survival (91.9 vs 96.2%; P ¼ 0.1). Age, race, primary surgery, stage, and grade are important prognostic factors for ESS. Excellent survival in patients with grade 1 and 2 disease of all stages supports the concept that these tumors are significantly different from grade 3 tumors. Ovarian-sparing surgeries may be considered in younger patients with early-stage disease.

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

“…The problem with regard to earlier studies is that the various conditions were aggregated, preventing meaningful analysis of any single variable (6)(7)(8)(9)(10)(11)(12)(13). Further, some recent studies are still using the older classification (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) …”

Endometrial sarcomas: an immunohistochemical and JAZF1 re-arrangement study in low-grade and undifferentiated tumors

“…16 In terms of prognostic significance, a study of 831 endometrial sarcomas from the Surveillance Epidemiology and End Results database reported worse survival in women over 52 years. 24 By far the most reliable prognostic factor in uterine sarcomas is stage. 15,20,22,24 However, the majority of uterine sarcomas in general present at stage I, 16,22,[24][25][26] therefore predicting behavior in low-stage tumors, particular low-grade endometrial stromal sarcoma, remains a challenge.…”

“…24 By far the most reliable prognostic factor in uterine sarcomas is stage. 15,20,22,24 However, the majority of uterine sarcomas in general present at stage I, 16,22,[24][25][26] therefore predicting behavior in low-stage tumors, particular low-grade endometrial stromal sarcoma, remains a challenge. The proportion of stage I tumors in our series was similarly high, constituting 61% of low-grade endometrial stromal sarcomas, 50% of undifferentiated endometrial sarcomas with nuclear uniformity and 29% of the nuclear pleomorphism group.…”

Myxoid Endometrial Stromal Sarcoma: A Case Report and Literature Review

“…The most common organ is ovary, although metastases of lung, bone, and bladder have been reported [8]. A study on 831 patients with all stages of ESS has shown that the 5-year disease-specific survival rate is more than 90% [9].…”

“…In recent research studies, the incidence of lymphnode metastases in ESS is reported to be 9.9% (28/282) or 7% (7/100). [9,11] Progestin or aromatase inhibitors can be considered for adjuvant therapy. However, currently there is no standard for appropriate dose, regimen, or duration of treatment because there are insufficient prospective and retrospective data [12].…”