title: Endometrial stromal sarcoma: a population-based analysis.
abstract: To determine independent prognostic factors for the survival of patients with endometrial stromal sarcoma (ESS), data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute from 1988 to 2003. Kaplan-Meier and Cox proportional hazards models were used for analyses. Of 831 women diagnosed with ESS, the median age was 52 years (range: 17-96 years). In total, 59.9% had stage I, 5.1% stage II, 14.9% stage III, and 20.1% had stage IV disease. Overall, 13.0, 36.1, and 34.7% presented with grades 1, 2, and 3, respectively. Patients with stage I-II vs III-IV disease had 5 years DSS of 89.3% vs 50.3% (P<0.001) and those with grades 1, 2, and 3 cancers had survivals of 91.4, 95.4, and 42.1% (P<0.001). In multivariate analysis, older patients, black race, advanced stage, higher grade, lack of primary surgery, and nodal metastasis were independent prognostic factors for poorer survival. In younger women (<50 years) with stage I-II disease, ovarian-sparing procedures did not adversely impact survival (91.9 vs 96.2%; P=0.1). Age, race, primary surgery, stage, and grade are important prognostic factors for ESS. Excellent survival in patients with grade 1 and 2 disease of all stages supports the concept that these tumors are significantly different from grade 3 tumors. Ovarian-sparing surgeries may be considered in younger patients with early-stage disease.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143, USA. chanjohn@obgyn.ucsf.edu
authors.forename: J K
authors.initials: JK
authors.lastname: Chan
authors.forename: N M
authors.initials: NM
authors.lastname: Kawar
authors.forename: J Y
authors.initials: JY
authors.lastname: Shin
authors.forename: K
authors.initials: K
authors.lastname: Osann
authors.forename: L-M
authors.initials: LM
authors.lastname: Chen
authors.forename: C B
authors.initials: CB
authors.lastname: Powell
authors.forename: D S
authors.initials: DS
authors.lastname: Kapp
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011379:Prognosis; D018426:SEER Program; D018203:Sarcoma, Endometrial Stromal / Q000401:mortality* / Q000473:pathology* / Q000601:surgery