Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA.
Department of Pathology, University of Washington Medical Center, Seattle, WA, USA.
Gynecol Oncol. 2018 May;149(2):297-300. doi: 10.1016/j.ygyno.2018.03.008. Epub 2018 Mar 11.
Low grade endometrial stromal sarcoma (LG-ESS) is a rare cancer with an indolent course. We aimed to assess the effectiveness of adjuvant hormonal suppression (HT) with or without oophorectomy (BSO) in prolonging progression free survival (PFS) and overall survival (OS) in patients with LG-ESS.
We performed a multi-institutional retrospective review of patients treated for low grade LG-ESS from 1985 to 2014. Demographics, treatment and recurrence data were abstracted from medical records. Pathologic diagnosis was confirmed by a gynecologic pathologist. Long-term patient-reported outcomes were obtained via mailed survey.
One-hundred-twelve patients underwent surgery for LG-ESS; 59 had postoperative data with a median follow-up of 55months (1-325months). The mean age at diagnosis was 48.5years (22-82years). Forty-nine (61%) had stage I disease. The most common presenting symptoms were abnormal uterine bleeding (38%) and pelvic mass (17%). Seventy-one (63%) patients had BSO at the time of diagnosis. Of the 59 patients with postoperative follow-up information, 49 (73%) underwent BSO, 26 (44%) received HT, 20 (33%) were expectantly managed, and 6 (10%) received chemotherapy, radiation or both. Median PFS for the entire group was 53months and OS was 63months. PFS for those who underwent BSO compared with those who retained their ovaries was 38 vs 11months, p=0.071. PFS for HT vs no HT was 28 vs 23months, p=0.77.
Consistent with prior series, our results support BSO to prolong PFS in LG-ESS but are limited by sample size. Larger studies with more complete follow-up are needed to determine the effect of adjuvant hormonal suppression.
低度子宫内膜间质肉瘤（LG-ESS）是一种罕见的癌症，其病程呈惰性。我们旨在评估辅助激素抑制（HT）联合或不联合卵巢切除术（BSO）对延长低级别 LG-ESS 患者无进展生存期（PFS）和总生存期（OS）的效果。
我们对 1985 年至 2014 年期间接受低级别 LG-ESS 治疗的患者进行了多机构回顾性研究。从病历中提取患者的人口统计学、治疗和复发数据。病理诊断由妇科病理学家确认。通过邮寄调查获得长期患者报告的结果。
122 例患者接受了 LG-ESS 的手术治疗；59 例患者术后数据中位随访时间为 55 个月（1-325 个月）。诊断时的平均年龄为 48.5 岁（22-82 岁）。49 例（61%）患者疾病分期为 I 期。最常见的首发症状是异常子宫出血（38%）和盆腔肿块（17%）。71 例（63%）患者在诊断时行 BSO。在有术后随访信息的 59 例患者中，49 例（73%）行 BSO，26 例（44%）接受 HT，20 例（33%）接受期待治疗，6 例（10%）接受化疗、放疗或两者联合治疗。全组中位 PFS 为 53 个月，OS 为 63 个月。BSO 组与保留卵巢组的 PFS 分别为 38 个月和 11 个月，p=0.071。HT 组与无 HT 组的 PFS 分别为 28 个月和 23 个月，p=0.77。
与之前的系列研究一致，我们的结果支持 BSO 延长 LG-ESS 的 PFS，但受到样本量的限制。需要更大规模、随访更完整的研究来确定辅助激素抑制的效果。
