Department of Radiation Oncology, University Hospital, Geneva, Switzerland.
Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):e757-63. doi: 10.1016/j.ijrobp.2011.11.005. Epub 2012 Jan 31.
To provide further understanding regarding outcome and prognostic factors of endometrial stromal tumors (EST).
A retrospective analysis was performed on the records of 59 women diagnosed with EST and treated with curative intent between 1983 and 2007 in the framework of the Rare Cancer Network.
Endometrial stromal sarcomas (ESS) were found in 44% and undifferentiated ESS (UES) in 49% of the cases. In 7% the grading was unclear. Of the total number of patients, 33 had Stage I, 4 Stage II, 20 Stage III, and 1 presented with Stage IVB disease. Adjuvant chemotherapy was administered to 12 patients, all with UES. External-beam radiotherapy (RT) was administered postoperatively to 48 women. The median follow-up was 41.4 months. The 5-year overall survival (OS) rate was 96.2% and 64.8% for ESS and UES, respectively, with a corresponding 5-year disease-free survival (DFS) rate of 49.4% and 43.4%, respectively. On multivariate analysis, adjuvant RT was an independent prognostic factor for OS (p = 0.007) and DFS (p = 0.013). Locoregional control, DFS, and OS were significantly associated with age (≤60 vs. >60 years), grade (ESS vs. UES), and International Federation of Gynecology and Obstetrics stage (I-II vs. III-IV). Positive lymph node staging had an impact on OS (p < 0.001).
The prognosis of ESS differed from that of UES. Endometrial stromal sarcomas had an excellent 5-year OS, whereas the OS in UES was rather low. However, half of ESS patients had a relapse. For this reason, adjuvant treatment such as RT should be considered even in low-grade tumors. Multicenter randomized studies are still warranted to establish clear guidelines.
进一步了解子宫内膜间质肿瘤（EST）的预后和预后因素。
对 1983 年至 2007 年间在罕见癌症网络框架内以治愈为目的治疗的 59 名 EST 诊断妇女的记录进行回顾性分析。
子宫内膜间质肉瘤（ESS）占 44%，未分化子宫内膜间质肉瘤（UES）占 49%。7%的分级不明确。在所有患者中，33 例为 I 期，4 例为 II 期，20 例为 III 期，1 例为 IVB 期。12 例 UES 患者接受了辅助化疗，48 例患者术后接受了外照射放疗（RT）。中位随访时间为 41.4 个月。ESS 和 UES 的 5 年总生存率（OS）分别为 96.2%和 64.8%，相应的 5 年无病生存率（DFS）分别为 49.4%和 43.4%。多因素分析显示，辅助 RT 是 OS（p = 0.007）和 DFS（p = 0.013）的独立预后因素。局部区域控制、DFS 和 OS 与年龄（≤60 岁与>60 岁）、分级（ESS 与 UES）和国际妇产科联合会分期（I-II 期与 III-IV 期）显著相关。阳性淋巴结分期对 OS 有影响（p<0.001）。
ESS 的预后与 UES 不同。子宫内膜间质肉瘤的 5 年 OS 极好，而 UES 的 OS 相当低。然而，一半的 ESS 患者有复发。因此，即使是低级别肿瘤，也应考虑辅助治疗，如 RT。仍需进行多中心随机研究，以制定明确的指南。
