Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Int J Gynecol Cancer. 2022 Jul 4;32(7):882-890. doi: 10.1136/ijgc-2022-003383.
To assess potential predictive variables for nodal metastasis and survival outcomes in patients with newly diagnosed, low-grade endometrial stromal sarcoma.
We performed a single-institution, retrospective analysis of consecutive patients with newly diagnosed, low-grade endometrial stromal sarcoma who presented between January 1, 1980 and December 31, 2019 and underwent hysterectomy at our institution or presented within 3 months of primary surgery elsewhere before recurrence. Patients who presented to our institution only at recurrence were excluded. Patients with <3 months of follow-up were excluded from survival analyses.
We identified 127 consecutive patients for analysis. Median age at diagnosis was 48 years (range 19-88 years); 91 (74.6%) of 127 were pre-menopausal; and 74 (58.3%) of 127 had uterine-confined, stage I tumors. Of 56 patients (44.1%) who underwent lymph node sampling, 10 (17.9%) had nodal metastasis. Of the 10 with nodal metastasis, 1 (10%) did not have lymphadenopathy or extra-uterine disease, 4 (40%) had lymphadenopathy only, 1 (10%) had extra-uterine disease only, and 4 (40%) had both. Among the 29 patients without apparent extra-uterine disease or gross lymphadenopathy, there was one occult lymph node metastasis (3.4%). Gross lymphadenopathy at time of surgery was predictive for lymph node metastasis (p<0.001). Median follow-up was 69 months (range 4-336) for the 95 patients included in the survival analyses. The 5-year progression-free survival and disease-specific survival rates were 79.8% and 90.8%, respectively. Patients with stage I tumors had longer progression-free survival than those with stage II-IV disease (p<0.001); there was no difference in disease-specific survival (p=0.63). Post-operative observation versus adjuvant therapy with hormone blockade or radiation therapy did not result in progression-free survival differences for stage I or completely resected stage II-IV disease (p=0.50 and p=0.81, respectively). Similarly, there was no disease-specific survival difference for completely resected stage II-IV disease (p=0.3).
Lymph node dissection in patients with low-grade endometrial stromal sarcoma should be reserved for those with clinically suspicious lymphadenopathy. Disease stage correlated with progression-free survival but not disease-specific survival. Post-operative therapy did not improve progression-free survival or disease-specific survival.
评估新诊断的低度子宫内膜间质肉瘤患者的淋巴结转移和生存结果的潜在预测变量。
我们对 1980 年 1 月 1 日至 2019 年 12 月 31 日期间在我院行子宫切除术或在复发前 3 个月内在其他地方行初次手术的新诊断的低度子宫内膜间质肉瘤连续患者进行了单机构回顾性分析。仅在复发时到我院就诊的患者被排除在外。随访时间<3 个月的患者被排除在生存分析之外。
我们共分析了 127 例连续患者。中位诊断年龄为 48 岁（19-88 岁）；91 例（74.6%）为绝经前；74 例（58.3%）为子宫内局限，I 期肿瘤。在 56 例行淋巴结取样的患者中，有 10 例（17.9%）有淋巴结转移。在 10 例淋巴结转移的患者中，1 例（10%）无淋巴结病或子宫外疾病，4 例（40%）仅有淋巴结病，1 例（10%）仅有子宫外疾病，4 例（40%）两者均有。在 29 例无明显子宫外疾病或明显淋巴结病的患者中，有 1 例（3.4%）存在隐匿性淋巴结转移。手术时的大体淋巴结病与淋巴结转移相关（p<0.001）。在纳入生存分析的 95 例患者中，中位随访时间为 69 个月（4-336）。5 年无进展生存率和疾病特异性生存率分别为 79.8%和 90.8%。I 期肿瘤患者的无进展生存率长于 II-IV 期疾病患者（p<0.001）；疾病特异性生存率无差异（p=0.63）。对于 I 期或完全切除的 II-IV 期疾病，术后观察与激素阻断或放射治疗的辅助治疗并未导致无进展生存率差异（p=0.50 和 p=0.81）。同样，对于完全切除的 II-IV 期疾病，无疾病特异性生存率差异（p=0.3）。
低度子宫内膜间质肉瘤患者的淋巴结清扫术应保留给临床可疑淋巴结病患者。疾病分期与无进展生存率相关，但与疾病特异性生存率无关。术后治疗并未改善无进展生存率或疾病特异性生存率。
