title: Ovary and uterus-sparing procedures for low-grade endometrial stromal sarcoma: a retrospective study of 153 cases.
abstract: OBJECTIVE
  To discuss the optimal treatment options for low grade endometrial stromal sarcoma (LG-ESS).
  
  
  METHODS
  Medical records of consecutive patients with LG-ESS in our institute were collected. The pertinent data, including clinicopathological characteristics, treatment and prognostic information were evaluated.
  
  
  RESULTS
  A total of 153 cases of LG-ESS were included. The 5-year relapse free survival (RFS), overall survival (OS) and survival after relapse (SAR) rates were 66.1%, 95.8% and 82.9%, respectively. Ovary-sparing procedures, positive resection-margins, and myomectomy were the independent adverse factors for relapse (P<0.0001, =0.0041, and =0.0075, respectively). Post-menopause, cervical involvement, and positive lymphovascular space involvement were significantly associated with survival (P<0.0001, =0.0020, and =0.0163, respectively). Distance recurrence and macroscopically residual tumors negatively affected SAR (P=0.0137 and =0.0004, respectively). No benefit was found for lymphadenectomy in terms of both RFS and OS (P=0.1187 and =0.5138, respectively). Initial ovary-sparing procedures and myomectomy had no impact on OS (P=0.0810 and =0.8845, respectively). Adjuvant treatment had a slightly beneficial effect both on OS and SAR.
  
  
  CONCLUSIONS
  Hysterectomy with bilateral salpingo-oophorectomy and complete resection of the macroscopic lesion should be treated as the initial and salvage mainstay treatments for LG-ESS patients. Ovary-sparing procedures could be considered for young women without cervical involvement; however, long-term follow-up should be mandatory. Myomectomy should only be conserved for young patients with a strong desire for future fertility, with fully informed consent; hysterectomy was recommended after the completion of pregnancy and delivery. However, the roles of lymphadenectomy and adjuvant treatment deserve further investigation.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Huimin
authors.initials: H
authors.lastname: Bai
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Dongyan
authors.initials: D
authors.lastname: Cao
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Huifang
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiang
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Wu
authors.affiliation: Department of Pathology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Quancai
authors.initials: Q
authors.lastname: Cui
authors.affiliation: Department of Pathology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China.
authors.forename: Jinghe
authors.initials: J
authors.lastname: Lang
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China. Electronic address: shenkeng@vip.sina.com.
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D010053:Ovary / Q000601:surgery*; D011247:Pregnancy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018203:Sarcoma, Endometrial Stromal / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000601:surgery*; D055815:Young Adult
keywords: ESS; Endometrial stromal sarcoma; Low grade; Prognosis; Recurrence; Treatment