Low-grade and high-grade endometrial stromal sarcoma: A National Cancer Database study

Seagle, Brandon Luke L.; Shilpi, Arunima; Buchanan, Samuel R.; Goodman, Chelain R.; Shahabi, Shohreh

doi:10.1016/j.ygyno.2017.05.036

Cited by 101 publications

(95 citation statements)

References 27 publications

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“…The prognosis of ESS primarily depends on the stage of disease at the time of initial diagnosis . Other independent predictors of poorer survival include older age at diagnosis, higher grade of disease, no surgery, residual tumor and adjuvant therapy . Tumor size and age have been shown to be of prognostic significance in stage I low‐grade ESS .…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay treatment for ESS consists of total hysterectomy and bilateral salpingo‐oophorectomy, while lymphadenectomy remains controversial in stage I–II of the disease. Adjuvant treatments, including chemotherapy, radiation and endocrine therapy, may have a role in advanced and recurrent disease . The 5‐year overall survival in stage I low‐grade ESS is excellent (IA 100%, IB 93.5%) .…”

Section: Introductionmentioning

confidence: 99%

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Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

Chin

Lin

et al. 2018

J of Obstet and Gynaecol

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Considering the characteristics of low-grade endometrial stromal sarcoma (ESS), such as relative indolent course, younger age at diagnosis and favorable prognosis, the fertility-preserving management of low-grade ESS has been described by several authors. We report a 34-year-old female with stage IB low-grade ESS who developed recurrence 7 years after neoadjuvant high-dose progestin therapy followed by fertility-preserving surgery and postoperative progestin therapy. The patient stopped progestin therapy and was disease free for 4 years after diagnosis but experienced recurrence with peritoneal dissemination at 7 years. Considering the tendency of late recurrence, long-term surveillance is necessary to ensure timely action. Long-term progestin treatment might be considered after complete remission even beyond 5 years. We performed a literature review and found that many of the cases did not meet solid pathological criteria of low-grade ESS. The diagnostic criteria of low-grade ESS (vs endometrial stromal nodule) should be deliberately documented for future studies of this rare disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

Chin

Lin

et al. 2018

J of Obstet and Gynaecol

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“…It seems reasonable to omit LND in patient populations without obvious extrauterine disease, clinically suspicious enlarged nodes or advanced sarcomas. However, others insist early and complete surgical resection including LND for HGESS is the best treatment . Though, the standard therapeutic strategy for ESS is TH plus BSO when the tumor is confined to the uterine corpus, with a risk of LNM being 10% in the entire population of ESS cases .…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the primary treatment for early stage is a total hysterectomy (TH) plus a bilateral salpingo‐oophorectomy (BSO) . Whether it is necessary for LGESS patients to undergo lymph node dissection (LND) accompanied with TH and BSO is still controversial since lymph node metastasis (LNM) are usually associated with an advanced grade as well as extra uterine disease, deep myometrial invasion and lymph‐vascular invasion …”

Section: Introductionmentioning

confidence: 99%

“…12 Whether it is necessary for LGESS patients to undergo lymph node dissection (LND) accompanied with TH and BSO is still controversial since lymph node metastasis (LNM) are usually associated with an advanced grade as well as extra uterine disease, deep myometrial invasion and lymph-vascular invasion. [15][16][17] The objective of our study was to explore the LNM rate in LGESS and whether LND can assist with prognostic or clinical benefits for patients with LGESS confined to the uterus with no distal metastasis during follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term impact of lymphadenectomies in patients with low‐grade, early‐stage uterine endometrial stroma sarcoma

Zhang

Wang

et al. 2020

J of Obstet and Gynaecol

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Aim The aim of our study was to investigate the lymph node metastasis (LNM) rate and effect of lymph node dissection (LND) in patients with stage I, low‐grade endometrial stromal sarcoma (LGESS). Methods Patients with stage I LGESS (n = 119) that underwent surgery from July 1969 to July 2017, following up over 48 years at the China National Cancer Center were retrospectively analyzed in this study. Results Surgical records and consulting data for patients with LGESS were analyzed to find that 47 patients received systematic pelvic LND. The number of patients with menopause in the LND(+) group were significantly lower than those in LND(−) group (2.1% vs 22.2%, P = 0.005), meanwhile, patients received bilateral salpingo‐oophorectomy procedure in LND(+) group were significantly higher than LND(−) (97.9% vs 58.3%, P < 0.001). Neither progression‐free survival nor overall survival was significantly improved in the LND(+) group even after propensity score matching although the progression‐free survival has a stronger trend in LND(+) population. Conclusion A systematic LND was not significantly associated with prognosis for patients with early‐stage LGESS. There is no sufficient indication for a systematic LND for patients with early‐stage LGESS. A systematic LND might be necessary if enlarged lymph nodes were detected by image graphology or observation during surgery.

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A nomogram for predicting overall survival in patients with low‐grade endometrial stromal sarcoma: A population‐based analysis

Zhang

et al. 2020

Cancer Communications

289

189

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Background Low‐grade endometrial stromal sarcoma (LG‐ESS) is a rare tumor that lacks a prognostic prediction model. Our study aimed to develop a nomogram to predict overall survival of LG‐ESS patients. Methods A total of 1172 patients confirmed to have LG‐ESS between 1988 and 2015 were selected from the Surveillance, Epidemiology and End Results (SEER) database. They were further divided into a training cohort and a validation cohort. The Akaike information criterion was used to select variables for the nomogram. The discrimination and calibration of the nomogram were evaluated using concordance index (C‐index), area under time‐dependent receiver operating characteristic curve (time‐dependent AUC), and calibration plots. The net benefits of the nomogram at different threshold probabilities were quantified and compared with those of the International Federation of Gynecology and Obstetrics (FIGO) criteria‐based tumor staging using decision curve analysis (DCA). Net reclassification index (NRI) and integrated discrimination improvement (IDI) were also used to compare the nomogram's clinical utility with that of the FIGO criteria‐based tumor staging. The risk stratifications of the nomogram and the FIGO criteria‐based tumor staging were compared. Results Seven variables were selected to establish the nomogram for LG‐ESS. The C‐index (0.814 for the training cohort and 0.837 for the validation cohort) and the time‐dependent AUC (> 0.7) indicated satisfactory discriminative ability of the nomogram. The calibration plots showed favorable consistency between the prediction of the nomogram and actual observations in both the training and validation cohorts. The NRI values (training cohort: 0.271 for 5‐year and 0.433 for 10‐year OS prediction; validation cohort: 0.310 for 5‐year and 0.383 for 10‐year OS prediction) and IDI (training cohort: 0.146 for 5‐year and 0.185 for 10‐year OS prediction; validation cohort: 0.177 for 5‐year and 0.191 for 10‐year OS prediction) indicated that the established nomogram performed significantly better than the FIGO criteria‐based tumor staging alone ( P < 0.05). Furthermore, DCA showed that the nomogram was clinically useful and had better discriminative ability to recognize patients at high risk than the FIGO criteria‐based tumor staging. Conclusions A prognostic nomogram was developed and validated to assist clinicians in evaluating prognosis of LG‐ESS patients.

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Low-grade and high-grade endometrial stromal sarcoma: A National Cancer Database study

Cited by 101 publications

References 27 publications

Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

Long‐term impact of lymphadenectomies in patients with low‐grade, early‐stage uterine endometrial stroma sarcoma

A nomogram for predicting overall survival in patients with low‐grade endometrial stromal sarcoma: A population‐based analysis

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