1 Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
2 Yale-New Haven Hospital-Smilow Cancer Center Tumor Registry, Yale University School of Medicine, New Haven, CT, USA.
Reprod Sci. 2019 May;26(5):600-608. doi: 10.1177/1933719118778801. Epub 2018 May 29.
To compare aromatase inhibitors (AIs) with progestins as adjuvant hormonal therapy(AHT) for low-grade endometrial stromal sarcomas (LGESSs).
We reviewed cases with LGESS at our institution from 1984 to 2017. Disease recurrence and recurrence-free survival (RFS) were assessed among patients who received AI, progestins, or no AHT.
Among 39 patients with LGESS, 18 received progestins, 13 received AI, and 8 received no AHT. Thirty patients had stage I disease, and 9 had stage II to IV disease. All underwent hysterectomies. Disease recurred in 70% (7/10) of stage I patients who received no AHT, compared to 14.3% (1/7) receiving AI, and 7.7% (1/13) receiving progestins ( P = .003). Among stage I patients taking AI, mean RFS was 153.1 months (95% confidence interval [CI]: 110-195.6) versus 306.2 months (95% CI: 259.7-352.6) for progestin patients and 90.8 months (95% CI: 56.8-124.9) for those who received no AHT. In stage II to IV patients, mean RFS was 148.5 months (95% CI: 148.5-148.5) and 120.8 months (95% CI: 55.8-185.9) for the AI and progestin groups, respectively. All stage II to IV patients received AHT. Among stage I patients, median follow-up time for RFS was 159.1 months for progestin patients, 52.6 months for AI, and 53.1 months for those who received no AHT. Of this, 69% of stage I patients taking progestins reduced/stopped treatment prematurely due to side effects. None of the patients taking AI discontinued treatment early.
Aromatase inhibitor is associated with longer RFS in patients with advanced LGESS, is better tolerated than progestins, and can be primary AHT for LGESS.
比较芳香化酶抑制剂（AIs）与孕激素作为低级别子宫内膜间质肉瘤（LGESSs）的辅助激素治疗（AHT）。
我们回顾了 1984 年至 2017 年在我院就诊的 LGESS 患者病例。评估了接受 AI、孕激素或未接受 AHT 的患者的疾病复发和无复发生存率（RFS）。
39 例 LGESS 患者中，18 例接受孕激素治疗，13 例接受 AI 治疗，8 例未接受 AHT。30 例患者为 I 期疾病，9 例为 II 至 IV 期疾病。所有患者均行子宫切除术。未接受 AHT 的 I 期患者中，70%（7/10）出现疾病复发，而接受 AI 的患者中为 14.3%（1/7），接受孕激素的患者中为 7.7%（1/13）（P =.003）。接受 AI 的 I 期患者中，平均 RFS 为 153.1 个月（95%置信区间[CI]：110-195.6），而接受孕激素的患者为 306.2 个月（95% CI：259.7-352.6），未接受 AHT 的患者为 90.8 个月（95% CI：56.8-124.9）。在 II 至 IV 期患者中，AI 和孕激素组的平均 RFS 分别为 148.5 个月（95% CI：148.5-148.5）和 120.8 个月（95% CI：55.8-185.9）。所有 II 至 IV 期患者均接受 AHT。在 I 期患者中，接受孕激素的患者 RFS 的中位随访时间为 159.1 个月，接受 AI 的患者为 52.6 个月，未接受 AHT 的患者为 53.1 个月。其中，69%接受孕激素治疗的 I 期患者因副作用过早减少/停止治疗。接受 AI 治疗的患者均未提前停药。
在晚期 LGESS 患者中，芳香化酶抑制剂与更长的 RFS 相关，其耐受性优于孕激素，可作为 LGESS 的主要 AHT。
