title: Prognostic significance of steroid receptor positivity and adjuvant progestogen use in endometrial stromal sarcoma.
abstract: BACKGROUND
  The prognostic significance of oestrogen and progesterone receptors (ER/PR) in endometrial stromal sarcoma (ESS) has conflicting reports in the literature, and the routine use of adjuvant progestogen is of uncertain efficacy.
  
  
  OBJECTIVE
  To examine the prognostic significance of ER/PR positivity and of primary adjuvant progestogen use with outcome in ESS.
  
  
  METHODS
  All women with a diagnosis of ESS in our tertiary institution and associated private practices over the last 23 years were included. Primary variables were ER/PR positivity and adjuvant progestogen use. Other variables included high-grade disease and extrauterine disease. The primary outcome was survival, and the secondary outcome was recurrence-free survival (both overall and at 5 years). Survival was calculated using the Kaplan-Meier method. Univariate analyses were performed with t-test for means and chi-squared test for proportions, and multivariate analysis was used to control for age.
  
  
  RESULTS
  35 women were included. ER/PR positivity was associated with a survival benefit (OR death 0.22, P = 0.02), but primary adjuvant progestogen was not. High-grade disease (OR 13, P = 0.02) and extrauterine disease (OR 8.7, P = 0.04) were associated with decreased survival. No variable significantly affected recurrence-free survival. Eight of ten cases of recurrence treated with progestogen have survived more than 3 years.
  
  
  CONCLUSIONS
  ER/PR positivity appears to be useful for prognosis, but routine administration of primary adjuvant progestogen is not supported. There may be a role for progestogen in ER/PR positive tumours with recurrence or incomplete surgical clearance, but further research is required.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Cade
authors.forename: Michael A
authors.initials: MA
authors.lastname: Quinn
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rome
authors.forename: Alexander
authors.initials: A
authors.lastname: Polyakov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D011372:Progestins / Q000627:therapeutic use*; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D018203:Sarcoma, Endometrial Stromal / Q000737:chemistry / Q000188:drug therapy* / Q000601:surgery
chemical_list: D011372:Progestins; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: endometrial stromal; endometrial stromal tumours; progestins; receptors; sarcoma; steroid