title: Stage IA vs. IB endometrial stromal sarcoma: does the new staging system predict survival?
abstract: OBJECTIVE
  To determine the correlation of the new FIGO staging system with survival in stage I patients with low-grade and high-grade endometrial stromal sarcomas.
  
  
  METHODS
  Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Kaplan-Meier log rank and Cox proportional hazards models were used for survival analysis and to identify possible predictors for survival.
  
  
  RESULTS
  The identified cohort included 464 women, 310 (67%) low-grade endometrial stromal sarcoma, 96 (21%) high-grade endometrial stromal sarcoma, and 58 (12%) unclassified endometrial stromal sarcoma. Among low-grade and high-grade endometrial stromal sarcomas, there was no significant demographic or clinico-pathologic difference between stages IA and IB. The 5-year overall survival was worse in high-grade endometrial stromal sarcoma than low-grade endometrial stromal sarcoma (45.4% vs. 97.2%, p<0.001). The difference in 5-year overall survival among women with low-grade endometrial stromal sarcoma between stages IA and IB was significant (100% vs. 93.5%, p=0.003), but not among women with high-grade endometrial stromal sarcoma (51.4% vs. 43.5%, p=0.27). Although age (p=0.001), race (p=0.005), and stage (p=0.004) were all significant prognostic factors in low-grade endometrial stromal sarcoma, only cervical involvement (p=0.02) was a significant predictor in high-grade endometrial stromal sarcoma.
  
  
  CONCLUSIONS
  The new staging system is appropriate for risk stratification in low-grade endometrial stromal sarcoma. The prognosis in high-grade endometrial stromal sarcoma seems to be most influenced by the presence of cervical involvement and not by tumor size as the staging criteria would suggest.
authors.affiliation: Department of Obstetrics and Gynecology Detroit Medical Center, Detroit, MI, USA. gunjalgarg@yahoo.com
authors.forename: G
authors.initials: G
authors.lastname: Garg
authors.forename: J P
authors.initials: JP
authors.lastname: Shah
authors.forename: E P
authors.initials: EP
authors.lastname: Toy
authors.forename: C S
authors.initials: CS
authors.lastname: Bryant
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: R T
authors.initials: RT
authors.lastname: Morris
mesh_terms: D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D018203:Sarcoma, Endometrial Stromal / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology