Outcome and prognostic factors in endometrial stromal tumors: a Rare Cancer Network study.
OBJECTIVE
To provide further understanding regarding outcome and prognostic factors of endometrial stromal tumors (EST).


METHODS
A retrospective analysis was performed on the records of 59 women diagnosed with EST and treated with curative intent between 1983 and 2007 in the framework of the Rare Cancer Network.


RESULTS
Endometrial stromal sarcomas (ESS) were found in 44% and undifferentiated ESS (UES) in 49% of the cases. In 7% the grading was unclear. Of the total number of patients, 33 had Stage I, 4 Stage II, 20 Stage III, and 1 presented with Stage IVB disease. Adjuvant chemotherapy was administered to 12 patients, all with UES. External-beam radiotherapy (RT) was administered postoperatively to 48 women. The median follow-up was 41.4 months. The 5-year overall survival (OS) rate was 96.2% and 64.8% for ESS and UES, respectively, with a corresponding 5-year disease-free survival (DFS) rate of 49.4% and 43.4%, respectively. On multivariate analysis, adjuvant RT was an independent prognostic factor for OS (p = 0.007) and DFS (p = 0.013). Locoregional control, DFS, and OS were significantly associated with age (≤60 vs. >60 years), grade (ESS vs. UES), and International Federation of Gynecology and Obstetrics stage (I-II vs. III-IV). Positive lymph node staging had an impact on OS (p < 0.001).


CONCLUSIONS
The prognosis of ESS differed from that of UES. Endometrial stromal sarcomas had an excellent 5-year OS, whereas the OS in UES was rather low. However, half of ESS patients had a relapse. For this reason, adjuvant treatment such as RT should be considered even in low-grade tumors. Multicenter randomized studies are still warranted to establish clear guidelines.
Department of Radiation Oncology, University Hospital, Geneva, Switzerland. Ulrike.schick@icr.ac.uk
Ulrike
U
Schick
Yasmin
Y
Bolukbasi
Juliette
J
Thariat
Roxolyana
R
Abdah-Bortnyak
Abraham
A
Kuten
Sefik
S
Igdem
Hale
H
Caglar
Zeynep
Z
Ozsaran
Kristina
K
Lössl
Ursula
U
Schleicher
Daniel
D
Zwahlen
Sylviane
S
Villette
Hansjörg
H
Vees
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D036821:Endometrial Stromal Tumors / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D035583:Rare Diseases / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D018203:Sarcoma, Endometrial Stromal / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult