title: Can proliferation biomarkers reliably predict recurrence in World Health Organization 2003 defined endometrial stromal sarcoma, low grade?
abstract: An estimated 1500-3000 invasive Endometrial Stromal Sarcomas (ESS) cases annually occur worldwide. Before 2003, ESS was divided as low and high grade ESS based on mitotic activity. In 2003 the WHO changed the names, excluded mitoses and made nuclear atypia and necrosis the essential diagnostic criteria to distinguish ESS, Low Grade (ESS-LG, recurrence-free survival >90%) and Undifferentiated Endometrial Sarcoma (UES, poor prognosis). We have evaluated in WHO2003 defined ESS-LG whether proliferation biomarkers predict recurrence. Using survival analysis, the prognostic value of classical mitosis counts (Mitotic Activity Index, MAI) in haematoxyllin-eosin (H&E) sections, and immunohistochemical proliferation biomarkers (Ki-67 and PhosphoHistone-3 (PPH3)) were examined in 24 invasive endometrial stromal sarcomas. Three of 24 (12.5%) ESS-LG recurred. The MAI, PPH3 and Ki-67 were all prognostic (P = 0.001, 0.002 and 0.03). MAI values were >3 in the recurrent cases, but never exceeded 10 (the classical threshold for low and high grade). Non-recurrent cases had 0 ≤ MAI ≤ 3. PPH3 and Ki67 counts can be easier to perform than MAI and therefore helpful in the diagnosis of ESS, Low Grade. In conclusion, in this small study of WHO2003 defined ESS-LG, high levels of proliferation as measured by MAI, PPH3 and Ki-67 are predictive of recurrence. Larger studies are required to confirm these results.
authors.affiliation: Department of Gynecology and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Feng
authors.forename: Anais
authors.initials: A
authors.lastname: Malpica
authors.forename: Ivar
authors.initials: I
authors.lastname: Skaland
authors.forename: Einar
authors.initials: E
authors.lastname: Gudlaugsson
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Robboy
authors.forename: Ingvild
authors.initials: I
authors.lastname: Dalen
authors.forename: Keqin
authors.initials: K
authors.lastname: Hua
authors.forename: Xianrong
authors.initials: X
authors.lastname: Zhou
authors.forename: Jan P A
authors.initials: JP
authors.lastname: Baak
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000235:genetics*; D049109:Cell Proliferation; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D004801:Eosine Yellowish-(YS); D005260:Female; D006416:Hematoxylin; D006657:Histones / Q000235:genetics*; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000235:genetics*; D008875:Middle Aged; D008940:Mitotic Index; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D011379:Prognosis; D018203:Sarcoma, Endometrial Stromal / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D014944:World Health Organization
chemical_list: D014408:Biomarkers, Tumor; D006657:Histones; D019394:Ki-67 Antigen; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin