title: Prognostic indicators in WHO 2003 low-grade endometrial stromal sarcoma.
abstract: OBJECTIVE
  Endometrial stromal sarcoma (ESS) has traditionally been divided into low and high grade, but the World Health Organization (WHO, 2003) has changed the definition. Since 2003, many studies have used the old criteria, and few have focused on WHO 2003-defined ESS low grade (ESS-LG). The aim of this study was to investigate prognosticators in ESS-LG.
  
  
  RESULTS
  We reviewed the WHO 2003 diagnostic criteria in 91 tumours (previously classified as ESS low and high grade). There were 68 cases of ESS-LG and 23 of undifferentiated endometrial sarcoma (UES). In the ESS-LG cases, the prognostic value of clinicopathological variables was studied. With a median follow-up of 79 months (range: 20-474 months), the recurrence and death rates were 5/68 (7%) and 1/68 (1.5%) in the ESS-LG cases. Ovarian preservation or no ovarian preservation (P < 0.0001, hazard ratio (HR) 10.4) and mitotic activity index (MAI) (0-3 versus >3, P = 0.005, HR 8.6) had independent prognostic value. Other frequently used MAI thresholds - age, tumour diameter, and vessel invasion - were not prognostic. Among patients without ovarian preservation (n = 61), none of 53 with MAI 0-3 suffered recurrence, contrasting with two of eight (25%) of those with MAI >3 (P = 0.003); one of these two recurrence patients died (P = 0.02). Among patients with ovarian preservation (n = 7), three (43%) suffered recurrence but none died, and MAI had no additional prognostic value.
  
  
  CONCLUSIONS
  In ESS-LG, ovarian preservation and MAI >3 are associated with increased risk of recurrence.
authors: Department of Gynaecology, Hospital of Fudan University, Shanghai, China. jingsakura@gmail.com
authors: Weiwei
authors: W
authors: Feng
authors: Keqin
authors: K
authors: Hua
authors: Einar
authors: E
authors: Gudlaugsson
authors: Yinhua
authors: Y
authors: Yu
authors: Xianrong
authors: X
authors: Zhou
authors: Jan P A
authors: JP
authors: Baak
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D008940:Mitotic Index; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D059351:Organ Sparing Treatments / Q000401:mortality; D010053:Ovary / Q000601:surgery; D011379:Prognosis; D018203:Sarcoma, Endometrial Stromal / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014944:World Health Organization