Ovarian preservation in stage I low-grade endometrial stromal sarcomas.
OBJECTIVE
To examine the impact of ovarian preservation in a case-control study of women with stage I low-grade endometrial stromal sarcomas.


METHODS
Patients with low-grade endometrial stromal sarcomas were identified at 5 institutions from 1976 to 2002. Cases were defined as patients who retained ovarian function; each case was matched to 2 control patients who underwent bilateral salpingo-oophorectomy (BSO). Immunostaining for estrogen and progesterone receptors was performed. Data were examined with Student t, chi(2), Cox regression, and Kaplan-Meier analyses.


RESULTS
Twelve premenopausal patients with low-grade endometrial stromal sarcomas who did not undergo BSO were matched to 24 controls. Of the 36 patients in the entire cohort, disease recurred in 14 (39%). Recurrences were identified in the pelvis, abdomen, lung, or lymphatics in both cases and controls. Disease recurred in 4/12 (33%) case patients, compared with 10/24 (42%) control patients (P = .63). When case patients were compared with controls, no differences in progression-free (91.3 months versus 68.6 months, P = .44) or overall survival (median survival not yet reached versus 406 months, P = .82) were identified. This study had 13% power to detect the observed difference in median disease-free survival. After controlling for use of adjuvant therapy and BSO, older age remained the only independent poor prognostic factor for progression-free survival (P = .008). Twenty-two available tumors demonstrated positivity for both estrogen and progesterone receptors.


CONCLUSIONS
Bilateral salpingo-oophorectomy did not appear to affect time to recurrence or overall survival. Retention of ovarian function may be an option for premenopausal women with low-grade endometrial stromal sarcomas.
Li
Andrew J
AJ
Department of Obstetrics/Gynecology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA. Andrew.Li@cshs.org
Giuntoli
Robert L
RL
Drake
Richard
R
Byun
Sharon Young
SY
Rojas
Francisco
F
Barbuto
Denise
D
Klipfel
Nancy
N
Edmonds
Pamela
P
Miller
David S
DS
Karlan
Beth Y
BY
D000328:Adult; D001707:Biopsy, Needle; D016022:Case-Control Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007150:Immunohistochemistry; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods; D017697:Premenopause; D011336:Probability; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018203:Sarcoma, Endometrial Stromal / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome