Huang Xiaodi, Peng Peng
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China.
Front Oncol. 2022 Jun 28;12:922757. doi: 10.3389/fonc.2022.922757. eCollection 2022.
Low-grade endometrial stromal sarcoma (LG-ESS) is a rare and indolent malignancy. Hormone therapy has been reported as an adjuvant treatment for LG-ESS, although its effectiveness is controversial. Here we aimed to investigate the effects of postoperative hormone therapy on recurrence in patients with uterine LG-ESS. Between January 2010 and December 2019, a total of 152 patients (23 with and 129 without fertility-sparing) with a diagnosis of primary uterine LG-ESS confirmed by pathologists were enrolled in this study. In the cohort without fertility-sparing, 22 (17.7%) patients had recurrence, and the median disease-free survival (DFS) was 47 (2-130) months; only one of these patients died of LG-ESS. No significant difference was found in recurrence between the groups with and without hormone therapy (p=0.802). However, subgroup analysis showed that hormone therapy decreased the recurrence rate in stage II-IV (p=0.001, HR 0.144, 95% CI: 0.038-0.548), but not in stage I disease (p=0.256). High-dose progestins notably reduced recurrence (p=0.012, HR 0.154, 95% CI: 0.036-0.660), whereas non-progestin therapy marginally influenced recurrence (p=0.054) compared with no hormone therapy in stage II-IV disease. Moreover, hormone therapy within 12 months was effective in reducing recurrence (p=0.038, HR 0.241, 95% CI: 0.063-0.922). Ovarian preservation (p=0.004, HR 6.250, 95% CI: 1.786-21.874) and negative expression of ER/PR (p=0.000, HR 23.249, 95% CI: 4.912-110.026) were high-risk factors for recurrence in patients without fertility-sparing. In the fertility-sparing cohort, 15 (65.2%) patients experienced recurrence, and the median DFS was 24 (3-107) months. Six patients successfully delivered healthy fetuses, and five received hormone therapy. Twelve patients finally accepted hysterectomy after repeated recurrence, and only two of them had given birth before surgery. Patients who received hormone therapy showed longer DFS, although this difference was not statistically significant (p=0.466). In conclusion, postoperative hormone therapy reduces recurrence in patients with stage II-IV uterine LG-ESS without fertility-sparing, and high-dose treatment with progestins within 12 months is recommended. Bilateral oophorectomy can also reduce the risk of recurrence. Patients with fertility-sparing have a high risk of recurrence and poor pregnancy outcomes, and hormone therapy may be a reasonable choice in postoperative management.
低级别子宫内膜间质肉瘤（LG-ESS）是一种罕见的惰性恶性肿瘤。激素治疗已被报道可作为LG-ESS的辅助治疗方法，尽管其有效性存在争议。在此，我们旨在研究术后激素治疗对子宫LG-ESS患者复发的影响。2010年1月至2019年12月，共有152例经病理学家确诊为原发性子宫LG-ESS的患者（23例保留生育功能，129例未保留生育功能）纳入本研究。在未保留生育功能的队列中，22例（17.7%）患者复发，无病生存期（DFS）的中位数为47（2 - 130）个月；这些患者中只有1例死于LG-ESS。激素治疗组和未治疗组之间在复发方面未发现显著差异（p = 0.802）。然而，亚组分析显示，激素治疗可降低II - IV期患者的复发率（p = 0.001，风险比[HR] 0.144，95%置信区间[CI]：0.038 - 0.548），但对I期疾病无效（p = 0.256）。高剂量孕激素显著降低复发率（p = 0.012，HR 0.154，95% CI：0.036 - 0.660），而在II - IV期疾病中，与未进行激素治疗相比，非孕激素治疗对复发的影响较小（p = 0.054）。此外，12个月内进行激素治疗可有效降低复发率（p = 0.
