Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Gynecol Oncol. 2012 Apr;125(1):141-4. doi: 10.1016/j.ygyno.2011.10.010. Epub 2011 Nov 23.
Endometrial stromal sarcoma (ESS) is a rare and indolent form of uterine cancer with ill-defined post-operative treatment guidelines. The goal of this study was to evaluate the rate of recurrence and the effect of various adjuvant treatment modalities.
Patients with ESS at 4 institutions were identified (1986-2007). Patient demographics, pathology, treatment, and follow-up information were collected. Chi-square statistical analysis was performed.
Forty-three patients with ESS were identified. All patients initially underwent hysterectomy. Twenty-eight (66.7%) had early stage, 12 (28.6%) had advanced stage ESS, and 2 (4.8%) had no staging information. Eight patients received pelvic and or vaginal cuff radiation treatment, with or without chemotherapy. Sixteen of 43 patients experienced a recurrence at an average of 100.5months. Thirty-three patients were treated with progestin therapy alone or followed expectantly. Complete outpatient records were available for 28 of these patients. Sixteen patients (57%) were followed expectantly while 12 (43%) received progestins. Patients receiving progestins vs. expectant management had a lower rate of recurrence in stage 1 (14.3% vs 38.5%, p=0.26) and all stages (33% vs 50%, p=0.38). Twenty-three of 28 (82.1%) patients underwent initial oophorectomy. Eight of 23 (34.8%) had a recurrence, compared to 4 of 5 (80%) in those who retained their ovaries (p=0.06).
ESS is a rare cancer that is difficult to study. We found removal of the adnexa and post-operative treatment with progestin therapy decreased recurrence rates. These two treatment strategies should be considered in the treatment of patients with all stages of ESS.
子宫内膜间质肉瘤（ESS）是一种罕见且惰性的子宫癌，其术后治疗指南尚不明确。本研究旨在评估复发率以及各种辅助治疗方式的效果。
在 4 家机构中确定了患有 ESS 的患者（1986-2007 年）。收集了患者的人口统计学、病理学、治疗和随访信息。采用卡方统计分析。
确定了 43 名患有 ESS 的患者。所有患者最初均接受了子宫切除术。28 例（66.7%）为早期，12 例（28.6%）为晚期 ESS，2 例（4.8%）无分期信息。8 例患者接受了盆腔和/或阴道残端放疗，同时或不联合化疗。43 例患者中有 16 例在平均 100.5 个月时复发。33 例患者单独接受孕激素治疗或接受期待治疗。在这些患者中有 28 例的完整门诊记录可供使用。16 例（57%）患者接受了期待治疗，而 12 例（43%）患者接受了孕激素治疗。接受孕激素治疗与期待治疗的患者在 1 期（14.3%比 38.5%，p=0.26）和所有分期（33%比 50%，p=0.38）的复发率均较低。28 例患者中有 23 例（82.1%）患者接受了初始卵巢切除术。23 例中有 8 例（34.8%）复发，而保留卵巢的 5 例中有 4 例（80%）复发（p=0.06）。
ESS 是一种罕见的癌症，难以研究。我们发现切除附件和术后孕激素治疗可降低复发率。这两种治疗策略应考虑用于治疗所有分期的 ESS 患者。
