Endometrial stromal sarcoma: prognostic factors and impact of adjuvant therapy in early stages

BACKGROUND AND OBJECTIVESEndometrial stromal sarcomas (ESS) are rare uterine neoplasms. Surgery remains the cornerstone of treatment for early stages and consists of an abdominal hysterectomy with bilateral salpingo-oopherectomy. Despite appropriate surgical treatment, relapse rates are high (18% to 45%) and the value of adjuvant therapies is not clear. We evaluated prognostic factors and the impact of adjuvant treatment on localized ESS (stages I and II).DESIGN AND SETTINGRetrospective, case-control study conducted at the National Institute of Oncology in Rabat, Morocco over 10 years from 2000 to 2009.PATIENTS AND METHODSTwenty-one cases of localized ESS were included in the analysis.RESULTSStandard surgery was performed in 71.4% of our patients. Myometrial invasion was noted in 57.1% of cases. Mitotic activity was considered high in five patients. Adjuvant treatment was given to 52.3% of patients: endocrine therapy in five patients and radiotherapy in six. Survival was significantly longer in the group of patients who underwent standard surgical treatment (P= .0007), in the absence of deep myometrial invasion (P= .0248) in cases with a low mitotic index (P< .0001) and in patients who received adjuvant therapy (hormone or radiotherapy) (P= .0048). In a multivariate analysis independent risk factors for monitoring were inadequate surgical treatment and absence of adjuvant treatment.CONCLUSIONSMyometrial invasion and mitotic index appear to be important prognostic factors. The reference surgery is hysterectomy with bilateral salpingo-oopherectomy. Lymph node dissection does not appear to provide a benefit. Finally adjuvant treatment may carry a significant survival benefit.