title: Endometrial stromal sarcomas: a retrospective analysis of 28 patients, single center experience for 20 years.
abstract: OBJECTIVE
  The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESSs) in relation to their clinical and pathogenic features, and to determine the optimal treatment strategy.
  
  
  METHODS
  A retrospective analysis was performed involving 28 patients with histologic-proven ESSs treated at our institution between 1987 and 2006.
  
  
  RESULTS
  The median follow-up was 54.7+/-63.1 months and the 5-year survival rate was 82.0%. Twenty-two (81.5%) and 5 patients (18.5%) had low- and high-grade disease, respectively. Univariate analysis revealed that the histologic grades, based on mitotic count, were associated with longer survival (p=0.004). However, among those patients with low-grade tumors, 5/20 patients (25%) had a recurrence and 2/21 patients (9.5%) had distant metastasis during the follow-up period. With the exception of 2 patients, 26 patients with ESSs underwent hysterectomy as primary treatment. Adjuvant treatment after surgery was administered to 14/26 patients (53.8%). Hormone therapy with progesterone, chemotherapy, and/or radiotherapy did not influence overall survival. However, the postoperative adjuvant therapy group, regardless of the treatment modality, was associated with relatively increased overall survival when compared to the surgery only group (p=0.054).
  
  
  CONCLUSIONS
  The preoperative differential diagnosis of ESSs from other benign gynecologic diseases is often difficult. We recommend adjuvant therapy be administered after hysterectomy in patients with ESS to prevent recurrence or distant metastasis.
authors.affiliation: Women's Cancer Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Nam
authors.forename: Jae Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Dae Woo
authors.initials: DW
authors.lastname: Lee
authors.forename: Si Young
authors.initials: SY
authors.lastname: Jang
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Hong
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Kim
authors.forename: Sang Wun
authors.initials: SW
authors.lastname: Kim
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