Clinical characteristics of endometrial stromal sarcoma from an academic medical hospital in China.

OBJECTIVES

The purpose of this study was to evaluate the clinical features, treatments, and outcomes of endometrial stromal sarcoma (ESS) in China.

METHODS

Seventy consecutive ESS patients were treated at Peking Union Medical College Hospital from 1983 to 2005, and 51 of them completed the treatment and follow-up. The demographic, clinicopathologic, treatment, and survival information was retrospectively reviewed. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression.

RESULTS

In all, the mean age of the patients was 43.5 years. Irregular vaginal bleeding and uterine enlargement were presented in 71.0% and 65.7% of the cases, respectively. Uterine cavity lesions were found in 17 patients (24.3%). Twenty-six cases (37.2%) were diagnosed preoperatively through diagnostic curettage. Among 51 patients who completed the treatment and follow-up in Peking Union Medical College Hospital, 37 were diagnosed as having low-grade ESS (LGESS) and 14 high-grade ESS, which is now classified as undifferentiated endometrial sarcoma (UES). The median overall survival time was 334 months, and the 5-year survival rate was 87.8%. Twenty-six of 51 patients, including 14 with LGESS and 12 with UES, developed disease recurrence. The tumor's classification, initial surgery, and adjuvant therapy were the factors related to the disease-free survival, whereas only the tumor's classification was associated with the overall survival.

CONCLUSIONS

Endometrial stromal sarcoma is a rare kind of uterine malignancy; the possibilities of preoperative diagnosis may be improved by diagnostic curettage. Low-grade ESS and UES represent 2 distinct clinical entities and should be treated as such. The tumor's classification may be the most important prognostic factor.