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Ghimire S, Shrestha P, Bhandari K. A rare case report of low-grade endometrial sarcoma: A surgical tale from Himalayas. Int J Surg Case Rep 2024; 117:109544. [PMID: 38507940 PMCID: PMC10966147 DOI: 10.1016/j.ijscr.2024.109544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION In the context of female genital tract malignancy, uterine sarcoma is considered the rarest form of the disease. Despite the inert nature of low-grade endometrial sarcoma, they must be meticulously diagnosed on time, with an exact grading of the severity and staging of the disease, which further guides the treatment modality and prognosis. CASE SUMMARY A married Asian female without any significant past medical and surgical history complained of abdominal distension and discomfort, which was progressive in nature, for which a radiological assessment was made that showed features suggestive of endometrial sarcoma. Total abdominal hysterectomy with sapingoopherectomy was done without any perioperative complications. Histology further confirmed the diagnosis. Post-operatively, the patient had an unremarkable hospital stay and was discharged home. DISCUSSION Endometrial stromal sarcoma is one of the rare malignant entities presenting usually in late adult females, but sometimes it can present at an earlier age as well. Abdominal masses in females, although usually overlooked as benign, can sometimes be associated with a malignant picture. Low-grade endometrial sarcomas have been seen to masquerade other minor benign cases, such as leiomyoma. Despite the rarity of such malignant conditions, diagnosis and management are rather straightforward, and post-operative patient prognosis has been found to be rewarding. CONCLUSION Among the uterine sarcoma cases, endometrial sarcoma comes under the malignant disease of the least occurrence. Compared to other malignant conditions, these patients present with minor symptoms like discomfort, which may go unchecked. The major factor that should be noted is the on-time diagnosis and appropriate choice of treatment modality. Overall, despite a minute prevalence and difficult diagnosis, the prognosis of the patient is rather good.
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Affiliation(s)
- Sagun Ghimire
- Department of Neurosurgery, B & B Hospital, Gwarko, Lalitpur, Nepal
| | - Pratima Shrestha
- Department of Gynecology and Obstetrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Kritick Bhandari
- KIST Medical College and Teaching Hospital, Gwarko, Imadol, Lalitpur 44600, Nepal.
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Fang C, Zhang Y, Zhang P, Zhu T. Prognostic factors of patients with recurrent uterine malignancies undergoing secondary cytoreductive surgery. BMC Womens Health 2024; 24:9. [PMID: 38166810 PMCID: PMC10762825 DOI: 10.1186/s12905-023-02708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Several studies have demonstrated that secondary cytoreductive surgery (SCS) for patients with recurrent uterine malignancies may improve the survival. However, the selection criteria for SCS remain to be defined. This study aimed to assess the outcome of SCS and to explore factors that may influence the prognosis. METHODS Data of patients with recurrent uterine malignancies who received SCS in our hospital between January 2005 and January 2015 were retrospectively analyzed. Patients were assigned into endometrial carcinoma (EC) group and uterine sarcoma (US) group. RESULTS 84 cases in total were involved in the study, including 47 cases with recurrent EC and 37 cases with recurrent US. The 5-year survival of cases with recurrent EC and recurrent US was 59.6% and 33.3%, respectively. Recurrent EC cases with a lower tumor grade (G1/G1-G2/G2), size of the largest tumor ≤ 6 cm, single recurrent tumor, a history of adjuvant therapy, as well as recurrent US cases with younger age, a longer disease-free interval (DFI) before SCS (≥ 12 months), no peritoneal dissemination, and a history of complete cytoreduction were associated with a longer survival. The number of recurrent tumors was found as an independent prognostic factor of SCS. CONCLUSION Recurrent EC cases with a lower tumor grade, smaller tumor size, single tumor, a history of adjuvant therapy, as well as recurrent US cases with younger age, a longer DFI before SCS, no peritoneal dissemination, and a history of complete cytoreduction were more likely to benefit from SCS.
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Affiliation(s)
- Chenyan Fang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Yingli Zhang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Ping Zhang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China
| | - Tao Zhu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang Province, China.
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Vujić G, Korda ZA, Kosi Bijelić N, Škopljanac Mačina A, Juranko V, Alfirević I, Mikuš M. Radical surgery of a recurrent low grade endometrial stromal sarcoma with a comprehensive intravenous growth from ovarian vein to the right ventricle - a case report. J OBSTET GYNAECOL 2023; 43:2186777. [PMID: 36920179 DOI: 10.1080/01443615.2023.2186777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Goran Vujić
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zvonimir Ante Korda
- Department of Cardiovascular Surgery, University Clinic for Cardiovascular Medicine Magdalena, Zagreb, Croatia
| | - Nina Kosi Bijelić
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Andrija Škopljanac Mačina
- Department of Cardiovascular Surgery, University Clinic for Cardiovascular Medicine Magdalena, Zagreb, Croatia
| | - Vlado Juranko
- Department of Cardiovascular Surgery, University Clinic for Cardiovascular Medicine Magdalena, Zagreb, Croatia
| | - Igor Alfirević
- Department of Cardiovascular Surgery, University Clinic for Cardiovascular Medicine Magdalena, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Zagreb, Croatia
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Kikuchi A, Yoshida H, Tsuda H, Nishio S, Suzuki S, Takehara K, Kino N, Sumi T, Kato K, Yokoyama M, Nakamura K, Takano M, Sato S, Kato H, Tamate M, Horie K, Kato T, Sakamoto A, Fukunaga M, Kaku T, Yoshida M, Yaegashi N, Satoh T. Clinical characteristics and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma confirmed by central pathologic review: A multi-institutional retrospective study from the Japanese Clinical Oncology Group. Gynecol Oncol 2023; 176:82-89. [PMID: 37478616 DOI: 10.1016/j.ygyno.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES Low-grade and high-grade endometrial stromal sarcomas (LGESS and HGESS) and undifferentiated uterine sarcomas (UUS) are rare tumors whose pathological classification and staging system have changed recently. These tumors are reported to contain fusion genes. We aimed to clarify the genetic background, clinical features, prognostic factors, and optimal therapy of these tumors using a new classification and staging system. METHODS We analyzed the clinical features and prognostic information of 72 patients with LGESS, 25 with HGESS, and 16 with UUS using central pathological review. Estrogen and progesterone receptors (PgRs) were examined by immunohistochemistry. JAZF1-SUZ12 and YWHAE-NUTM2A/B gene fusions were tested using real-time polymerase chain reaction. RESULTS The 5-year overall survival (OS) rates of LGESS, HGESS, and UUS were 94%, 53%, and 25%, respectively. In LGESS, stage IV, incomplete surgery, and absence of PgR were associated with poor OS. The presence of JAZF1-SUZ12 fusion gene was not associated with OS. In HGESS, the relationship between stage and prognosis was unclear. None of the 3 patients with YWHAE-NUTM2A/B fusion gene died during follow-up. Adjuvant chemotherapy was associated with a favorable OS. Incomplete resection of UUS was associated with poor OS; however, residual tumors frequently occurred. Although most patients underwent adjuvant chemotherapy, their prognosis was extremely poor even in stage I disease. CONCLUSIONS Prognosis of LGESS is generally good; however, stage IV, incomplete surgery, and PgR-negative tumors are associated with poor prognosis. Adjuvant chemotherapy may be useful for HGESS. Prognosis of UUS is extremely poor, even with adjuvant chemotherapy.
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Affiliation(s)
- Akira Kikuchi
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan.
| | - Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Shiro Suzuki
- Department of Gynecologic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuhiro Takehara
- Department of Gynecologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Nao Kino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Saga University Faculty of Medicine, Saga, Japan
| | - Kazuto Nakamura
- Department of Gynecology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Tamate
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Koji Horie
- Department of Gynecology, Saitama Cancer Center, Kita Adachi Gun, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuhiko Sakamoto
- Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, Tokyo, Japan
| | - Masaharu Fukunaga
- Department of Pathology, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Tsunehisa Kaku
- Center for Preventive Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Salehi M, Sheidaei S, Jafari HR, Jafari A. Utero-ovarian low grade endometrial stromal sarcoma, a case report. Int J Surg Case Rep 2023; 106:108296. [PMID: 37148730 DOI: 10.1016/j.ijscr.2023.108296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Endometrial stromal sarcoma (ESS) is a rare malignancy of uterine in middle aged women. There are numerous subtypes for ESS which share the same clinical picture of uterine bleeding and pelvic pain. Consequently, diagnosis and treatment modalities of LG-ESS with metastasis are challenging. However, both molecular and immunological study of samples can be useful. CASE PRESENTATION In this case study, we report a 52-year-old woman presenting with the chief complaint of unusual uterine bleeding. There was no specific finding in her past medical history. The CT study revealed enlarged bilateral ovary with a significantly large left ovarian mass and suspicious mass in uterus. By the diagnosis of ovarian mass, patient went under total abdominal hysterectomy with bilateral salpingo-oophorectomy (BSO), greater omentectomy, and appendectomy followed by post-op hormone therapy. Her follow-up was uneventful. The IHC and pathological study of samples revealed incidental LG-ESS uterus mass with metastasis to ovaries despite her primary diagnosis. DISCUSSION LG-ESS has low metastasis rate. Surgical modalities and neoadjuvant therapies are recommended base on the stage of ESS. In the following study, we represent a case of incidental LG-ESS with bilateral ovarian invasion who was initially diagnosed as an ovarian mass. CONCLUSION Our patient was successfully managed by surgical intervention. Despite scarcity of LG-ESS, it is advised to consider LG-ESS as a differential diagnosis in management of patients with a uterus mass with bilateral ovarian involvement.
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Affiliation(s)
- Mahsa Salehi
- Mazandaran University of Medical Sciences, Mazandaran, Iran
| | | | | | - Afrooz Jafari
- Shahrekord University of Medical Sciences, Shahrekord, Iran
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Pérez-Fidalgo JA, Ortega E, Ponce J, Redondo A, Sevilla I, Valverde C, Isern Verdum J, de Alava E, Galera López M, Marquina G, Sebio A. Uterine sarcomas: clinical practice guidelines for diagnosis, treatment, and follow-up, by Spanish group for research on sarcomas (GEIS). Ther Adv Med Oncol 2023; 15:17588359231157645. [PMID: 37007636 PMCID: PMC10052607 DOI: 10.1177/17588359231157645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Uterine sarcomas are very infrequent and heterogeneous entities. Due to its rarity, pathological diagnosis, surgical management, and systemic treatment are challenging. Treatment decision process in these tumors should be taken in a multidisciplinary tumor board. Available evidence is low and, in many cases, based on case series or clinical trials in which these tumors have been included with other soft tissue sarcoma. In these guidelines, we have tried to summarize the most relevant evidence in the diagnosis, staging, pathological disparities, surgical management, systemic treatment, and follow-up of uterine sarcomas.
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Affiliation(s)
| | - Eugenia Ortega
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jordi Ponce
- Gynecology Department, Hospital Universitario de Bellvitge. IDIBELL. Universidad de Barcelona, Barcelona, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Isabel Sevilla
- Clinical and Translational Research in Cancer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional and Virgen de la Victoria de Málaga, Málaga, Spain
| | - Claudia Valverde
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Josep Isern Verdum
- Radiotherapy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique de Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Sevilla, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - Mar Galera López
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, IdISSC, Spain
- Department of Medicine, School of Medicine, Complutense University (UCM), Madrid, IdISSC, Spain
| | - Ana Sebio
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Li Y, Gong Q, Peng J, Liu Y, Jiang Y, Zhang S. Prognostic significance of lymphadenectomy in uterine leiomyosarcomas and endometrial stromal sarcomas: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 279:94-101. [DOI: 10.1016/j.ejogrb.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/04/2022]
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Wang F, Dai X, Chen H, Hu X, Wang Y. Clinical characteristics and prognosis analysis of uterine sarcoma: a single-institution retrospective study. BMC Cancer 2022; 22:1050. [PMID: 36207687 PMCID: PMC9540718 DOI: 10.1186/s12885-022-10129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Uterine sarcomas are rare and aggressive gynaecologic malignancies, characterized by a relatively high recurrence rate and poor prognosis. The aim of this study was to investigate the clinicopathological features and explore the prognostic factors of these malignancies. Methods This was a single-institution, retrospective study. We reviewed the medical records of 155 patients with pathologically confirmed uterine sarcomas including uterine leiomyosarcoma (ULMS), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma (UUS) and adenosarcoma (AS) between 2006 and 2022. A total of 112 patients who underwent surgery between January 2006 and April 2019 were included in the survival analysis. The current study recorded the clinicopathological, treatment and outcome data to determine clinical characteristics and survival. Results The most common histopathological type was ULMS (63/155, 40.64%), followed by LG-ESS (56/155, 36.13%) and HG-ESS (16/155, 10.32%). The mean age at diagnosis of all patients was 49.27±48.50 years and 32.90% (51/155) of patients were postmenopausal. Fifteen patients underwent fast-frozen sectioning, 63(54.78%) were diagnosed with malignancy, 29(25.22%) were highly suspected of malignancy that needed further clarification and 23(14.84%) were diagnosed with benign disease. A total of 124(80%) patients underwent total hysterectomy (TH) and salpingo-oophorectomy. Multivariate analyses showed that histological type and tumour size were independent prognostic factors both for overall survival (OS) (p<0.001 and P=0.017, respectively) and progression-free survival (PFS) (p<0.001 and P=0.018, respectively). Tumour stage was only significantly associated with PFS (P=0.002). Elevated preoperative NLR, PLR and postmenopausal status were significantly correlated with shorter PFS and OS in univariate analysis, but no statistically significant difference was found in multivariate analysis. Conclusions In patients with uterine sarcoma, in comparison to LMS and LG-ESS, UUS and HG-ESS tend to present as more aggressive tumour with poorer outcomes. Furthermore, larger tumour (>7.5 cm) were an important predictor of shorter PFS and OS.
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Affiliation(s)
- Fang Wang
- Department of Pathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinyue Dai
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China
| | - Huijun Chen
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China
| | - Xiaoli Hu
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China.
| | - Yuanqiu Wang
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, China.
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Borella F, Bertero L, Cassoni P, Piovano E, Gallio N, Preti M, Cosma S, Ferraioli D, Pace L, Mariani L, Biglia N, Benedetto C. Low-Grade Uterine Endometrial Stromal Sarcoma: Prognostic Analysis of Clinico-Pathological Characteristics, Surgical Management, and Adjuvant Treatments. Experience From Two Referral Centers. Front Oncol 2022; 12:883344. [PMID: 35847944 PMCID: PMC9280128 DOI: 10.3389/fonc.2022.883344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Low-grade uterine endometrial stromal sarcoma (LG-ESS) is a rare tumor characterized by an overall good survival but showing a indolent behavior and a variable risk of recurrence. There is no clear consensus on the optimal management of these tumors and no prognostic or predictive factors have been established. With this study, we evaluated the prognostic relevance of several clinical, surgical, and pathological features in patients affected by LG-ESS to identify risk factors associated with recurrence. Methods We retrospectively analyzed 52 LG-ESS cases, treated from January 1st, 1994, to May 31st, 2020, in two referral centers. The relationship between recurrence and clinicopathological characteristics as well as surgical treatment was investigated. Risk of recurrence and disease-free survival (DFS) were estimated by Cox regression and the Kaplan-Meier analysis, respectively. Results Of 52 patients with LG-ESS, 8 experienced recurrence (15%). The median follow-up was 100 months (SD ± 96, range: 15–336). By univariate analysis, fragmentation/morcellation, tumor size, FIGO stage, higher mitotic count, presence of necrosis, and lymphovascular space invasion (LSVI) resulted associated with a poorer outcome. Conversely, the surgical modality (laparotomic vs laparoscopic and hysterectomy with bilateral salpingo-oophorectomy vs local excision) and pelvic lymphadenectomy were not. Even the different modalities of adjuvant therapy (hormonal therapy, radiotherapy, and chemotherapy) showed no prognostic significance. Tumor fragmentation/morcellation and higher mitotic count resulted independent prognostic variables at multivariate analysis. Conclusions This data supports the avoidance of any type of morcellation if LG-ESS is suspected preoperatively. Higher mitotic count and, possibly, tumor size, advanced FIGO stage, necrosis, and LVSI could be exploited to tailor the adjuvant therapy, but these results need to be confirmed in larger prospective studies.
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Affiliation(s)
- Fulvio Borella
- Division of Gynecology and Obstetrics 1, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
- *Correspondence: Fulvio Borella,
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
| | - Elisa Piovano
- Division of Gynecology and Obstetrics 3, “City of Health and Science University Hospital”, Turin, Italy
| | - Niccolò Gallio
- Division of Gynecology and Obstetrics 1, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Preti
- Division of Gynecology and Obstetrics 1, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Stefano Cosma
- Division of Gynecology and Obstetrics 1, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Luca Pace
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Obstetrics and Gynecology University Department, Mauriziano Umberto I Hospital, Turin, Italy
| | - Luca Mariani
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Obstetrics and Gynecology University Department, Mauriziano Umberto I Hospital, Turin, Italy
| | - Nicoletta Biglia
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Obstetrics and Gynecology University Department, Mauriziano Umberto I Hospital, Turin, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, “City of Health and Science University Hospital”, University of Turin, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Huang Y, Lin Y, Li Y, Chu K, Zhou Y, Lin L, Zhou R, Zhang Z, Lin Q. Adjuvant radiotherapy shows benefit in selected stage I uterine sarcoma: A risk scoring system based on a population analysis. Cancer Med 2022; 11:2846-2854. [PMID: 35277934 PMCID: PMC9302311 DOI: 10.1002/cam4.4643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background The potential therapeutic benefit of adjuvant radiotherapy for patients with stage I uterine sarcoma has not been clear. In this study, we aimed to develop a risk scoring model to select the subgroup of patients with stage I uterine sarcoma who might benefit from adjuvant radiotherapy. Methods Patients with stage I uterine sarcoma from the Surveillance, Epidemiology, and End Results program from 2010 to 2014 were retrospectively included in this analysis. Cox proportional hazards models were performed to identify risk factors. Results A total of 947 stage I uterine sarcoma patients were included. The 5‐year disease‐specific survival (DSS) of the overall cohort was 75.81%. Multivariate analysis identified stage (p = 0.013), tumor grade (p <0.001) and histology (p = 0.043) as independent prognostic factors for DSS, and these factors were used to generate the risk scoring model. The low‐risk group presented a better DSS than the high‐risk group (95.51% vs. 49.88%, p < 0.001). The addition of radiotherapy to surgery significantly increased the DSS in the high‐risk group compared with surgery alone (78.06% vs. 46.88%, p = 0.022), but no significant survival benefit was observed in the low‐risk group (98.36% vs. 100%, p = 0.766). Conclusions Our risk scoring model based on stage, tumor grade, and histology predicted the outcome of patients with stage I uterine sarcoma cancer. This system may help to select stage I uterine sarcoma cancer patients who might benefit from adjuvant radiotherapy.
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Affiliation(s)
- Yun‐xia Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yan‐zong Lin
- Department of General Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yi‐min Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Ke‐xin Chu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Yu‐fei Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Li‐mei Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Rui Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Zong‐kai Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
| | - Qin Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University Teaching Hospital of Fujian Medical University Xiamen China
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Meng Y, Quan Q, Zhang F, Liu Y, Ren S, Mu X. Prognostic Value of Ki-67 Index in Patients With Endometrial Stromal Sarcoma. Front Med (Lausanne) 2022; 8:823505. [PMID: 35145981 PMCID: PMC8821648 DOI: 10.3389/fmed.2021.823505] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Ki-67 index is used to evaluate cell proliferation activity, which is related to tumor progression, metastasis, and prognosis. We aimed to explore the prognostic value of Ki-67 index in endometrial stromal sarcoma and to explore the optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma. Methods A total of 82 patients with endometrial stromal sarcoma who were treated in our hospital were collected. Clinicopathological data of these patients were retrospectively analyzed. Ki-67 index was detected by the immunohistochemical method. Receiver operating characteristic curve and the Youden index were performed to determine the optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma. The Cox regression was performed to analyze risk factors affecting prognosis of endometrial stromal sarcoma. The Kaplan–Meier method and Log-rank test were performed to analyze the survival of patients. Results The optimal cut-off value of Ki-67 index for predicting recurrent endometrial stromal sarcoma was 35%. The results of univariate analysis showed that high Ki-67 index (≥35%) was statistically significantly bound up with shorter progress free survival and overall survival. The results of multivariate analysis showed that Ki-67 index (P = 0.001) and ovarian preservation (P = 0.040) were independent prognostic factors of progress free survival. Conclusions A Ki-67 index cut-off of 35% was optimal for predicting recurrent endometrial stromal sarcoma. Ki-67 index may be a useful prognostic marker in endometrial stromal sarcoma.
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Affiliation(s)
- Yu Meng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Quan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenfen Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Liu
- Department of Obstetrics and Gynecology, Chengdu First People Hospital, Chengdu, China
| | - Siling Ren
- Department of Obstetrics, Chongqing Fuling District Maternal and Child Health Care, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xiaoling Mu
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12
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Bai H, Yuan F, Liang B, Sun H, Gao Y, Jin M, Xing X. Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma: A retrospective study of 40 cases. Medicine (Baltimore) 2022; 101:e28490. [PMID: 35029198 PMCID: PMC8758035 DOI: 10.1097/md.0000000000028490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS).The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated.A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P < .001, =.002, <.001, =.004, <.001, and <.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively.HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.
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Affiliation(s)
- Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the Affiliated Hospital Qingdao University, Qingdao, China
| | - Bing Liang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hengzi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yutao Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Xing
- Department of Pathology, the Affiliated Hospital Qingdao University, Qingdao, China
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13
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Gao L, Lyu J, Luo X, Zhang D, Jiang G, Zhang X, Gao X, Zheng S, Wang X, Shen Y. Nomogram to predict overall survival based on the log odds of positive lymph nodes for patients with endometrial carcinosarcoma after surgery. BMC Cancer 2021; 21:1149. [PMID: 34702197 PMCID: PMC8549209 DOI: 10.1186/s12885-021-08888-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Aims to compare the prognostic performance of the number of positive lymph nodes (PLNN), lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) and establish a prognostic nomogram to predict overall survival (OS) rate for patients with endometrial carcinosarcoma (ECS). METHODS Patients were retrospectively obtained from Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015. The prognostic value of PLNN, LNR and LODDS were assessed. A prediction model for OS was established based on univariate and multivariate analysis of clinical and demographic characteristics of ECS patients. The clinical practical usefulness of the prediction model was valued by decision curve analysis (DCA) through quantifying its net benefits. RESULTS The OS prediction accuracy of LODDS for ECS is better than that of PLNN and LNR. Five factors, age, tumor size, 2009 FIGO, LODDS and peritoneal cytology, were independent prognostic factors of OS. The C-index of the nomogram was 0.743 in the training cohort. The AUCs were 0.740, 0.682 and 0.660 for predicting 1-, 3- and 5-year OS, respectively. The calibration plots and DCA showed good clinical applicability of the nomogram, which is better than 2009 FIGO staging system. These results were verified in the validation cohort. A risk classification system was built that could classify ECS patients into three risk groups. The Kaplan-Meier curves showed that OS in the different groups was accurately differentiated by the risk classification system and performed much better than FIGO 2009. CONCLUSION Our results indicated that LODDS was an independent prognostic indicator for ECS patients, with better predictive efficiency than PLNN and LNR. A novel prognostic nomogram for predicting the OS rate of ECS patients was established based on the population in the SEER database. Our nomogram based on LODDS has a more accurate and convenient value for predicting the OS of ECS patients than the FIGO staging system alone.
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Affiliation(s)
- Linzhi Gao
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, China
| | - Xiaoya Luo
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Dong Zhang
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Guifang Jiang
- Department of Gynecology and Obstetrics, The Affiliated Shunde Hospital of Jinan University, 50 East Guizhou Avenue, Shunde District, Foshan, China
| | - Xian Zhang
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Xuesong Gao
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Shaolie Zheng
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China
| | - Xiaoyu Wang
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China.
| | - Yuan Shen
- Department of Gynaecology, The First Affiliated Hospital of Jinan University, 613 Whampoa Avenue, Tianhe District, Guangzhou, 510632, China.
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[Interdisciplinary S2k guidelines on the diagnosis and treatment of uterine sarcomas-recommendations for surgical pathology]. DER PATHOLOGE 2021; 41:621-633. [PMID: 32940744 DOI: 10.1007/s00292-020-00826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Uterine sarcomas represent a heterogeneous group of rare malignancies, derived from the myometrium, the endometrial stroma, and very rarely from the nonspecialized uterine soft tissue. The actual incidence is about 1.5 for Caucasian and 3.0 for Afro-American women. There is no grading system for leimoysarcoma defined by the WHO classification; however, if clinicians request, the FNCLCC grading can be specified in analogy to soft tissue sarcomas. Adenosarcomas must be distinguished from adenofibromas (the existence of which is questionable)-with the vast majority of these tumors being uterine adenosarcomas. Within adenosarcomas, deep myometrial invasion (>50%), sarcomatous overgrowth, and a high-grade heterologous component are associated with a higher recurrence rate and poor survival. The immunohistochemical panel represents a very helpful tool for distinguishing low-grade from high grade endometrial stromal sarcomas (ESS) and may be supplemented by molecular analyses. Steroid hormone receptor analysis should be performed for all ESS due to the possible therapeutic relevance. Undifferentiated uterine sarcomas represent a diagnosis of exclusion and have a very poor prognosis. Carcinosarcomas represent a special subtype of endometrial carcinomas and are in fact not uterine sarcomas. Uterine sarcomas may present substantial intratumoral heterogeneity and adequate embedding is mandatory. Lesions ≤2 cm in the largest dimension should be processed completely and larger tumors should be processed with one block per centimeter for the largest tumor dimension.
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15
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Ayhan A, Toptas T, Oz M, Vardar MA, Kayikcioglu F, Ozgul N, Gokcu M, Simsek T, Tunc M, Meydanli MM. Low-grade endometrial stromal sarcoma: A Turkish uterine sarcoma group study analyzing prognostic factors and disease outcomes. Gynecol Oncol 2020; 160:674-680. [PMID: 33375988 DOI: 10.1016/j.ygyno.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate factors associated with refractory disease, recurrence, or death as well as disease-free survival (DFS) and overall survival (OS) in low-grade endometrial sarcoma (LGESS). METHODS A multi-institutional, retrospective study was conducted in a total of 124 patients, who received a curative-intent surgery. The exclusion criteria were as follows: i) history of any other invasive disease; ii) neoadjuvant therapy; iii) fertility sparing surgery; iv) a different diagnosis after review of the slides. RESULTS All patients underwent hysterectomy, 96% had bilateral salpingo-oophorectomy, and 65% had lymphadenectomy. Twelve (14.8%) of 81 patients undergoing lymphadenectomy had lymph node (LN) metastasis. Of those, 8 (9.8%) had pelvic LN metastasis whereas 4 (5.6%) had isolated paraaortic LN metastasis. Six of 8 (75%) patients with positive pelvic LNs had concurrent paraaortic LN metastasis. Among 124 patients, 3 patients (2.4%) had refractory disease following primary therapy. During a median follow-up of 45.5 months, 27 (22.3%) of 121 patients who achieved complete remission after primary therapy developed recurrence, and 10 patients (8.1%) died of disease. The 3-year DFS and OS were 76.9% and 93.8%, respectively. Stage was the sole independent prognostic factor in the whole cohort. When analyzing factors within subgroups of stage I and stage ≥II, there was no significant prognostic factor for stage I; however, lymphadenectomy and adjuvant chemotherapy were significantly associated with disease outcomes for stage ≥II. While lymphadenectomy was related with improved DFS, chemotherapy was associated with poor DFS and OS. CONCLUSION The risk of LN metastasis at pelvic as well as paraaortic lymphatic basins is not negligible to omit lymphadenectomy in stage ≥II LGESS. Moreover, lymphadenectomy provides significant DFS advantage in patients with extrauterine disease.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey.
| | - Murat Oz
- Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Vardar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fulya Kayikcioglu
- Department of Gynecologic Oncology, Saglik Bilimleri University Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Nejat Ozgul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Saglik Bilimleri University Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tayup Simsek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Tunc
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey
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Fels Elliott DR, Pekmezci M, Geiersbach KB, Krings G, Rabban JT, Zaloudek C, Chen YY. Low-grade endometrial stromal sarcoma metastatic to the breast: Immunohistochemical and molecular characterization of an unusual mimic of mammary myofibroblastoma. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Karataşlı V, Çakır İ, Can B, Erkılınç S, Karadeniz T, Kuru O, Gökçü M, Sancı M. Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma? J OBSTET GYNAECOL 2020; 41:797-802. [PMID: 33063586 DOI: 10.1080/01443615.2020.1803238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Surgical treatment of low-grade endometrial stromal sarcoma consists of hysterectomy. The role of oophorectomy is yet to be established. We aimed to examine the effect of preserving the ovaries on the pattern of recurrences in patients with stage I disease. Thirty-four patients with stage I low-grade endometrial stromal sarcoma were retrospectively analysed. Based on ovarian preservation the whole cohort was divided into two groups. Recurrence (liver, lung, groin and bone) was detected in 4 (11.8%) cases. No significant differences in overall survival or disease-free survival (DFS) were observed between the ovarian preservation and bilateral salpingo-oophorectomy (BSO) groups. Subset analysis revealed no significant difference in DFS between the ovarian preservation and BSO groups in the premenopausal arm. And also, the performance of pelvic (n = 2) or para-aortic lymphadenectomy (n = 6) or adjuvant hormonal therapy did not alter DFS significantly. The 5-year DFS rate for the group which received adjuvant radiotherapy was 62.5 and 94.4% for those which did not (p = .014). Preserving the ovaries had no adverse effect on the recurrence of stage I disease.IMPACT STATEMENTWhat is already known on this subject? Due to the rarity of the disease and the common postoperative diagnosis, only retrospective studies have been reported on low-grade endometrial stromal sarcoma. This disease is commonly diagnosed in premenopausal patients during the early stage. There is no consensus on preserving the ovaries, particularly in young patients, due to the tumour's hormonal characteristics and the risk of late recurrences.What do the results of this study add? Ovarian preservation had no effect on the recurrence of stage I low-grade endometrial stromal sarcoma. Lymphadenectomy and adjuvant hormonal treatment had no effect on DFS, and adjuvant radiotherapy decreased DFS in the current study.What are the implications of these findings for clinical practice and/or further research? Ovarian preservation should be considered, to prevent the negative effects of surgical menopause, particularly in young patients.
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Affiliation(s)
- Volkan Karataşlı
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - İlker Çakır
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Behzat Can
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Selçuk Erkılınç
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tuğba Karadeniz
- Department of Pathology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Oğuzhan Kuru
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Gökçü
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Muzaffer Sancı
- Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Wu J, Zhang H, Li L, Hu M, Chen L, Wu S, Xu B, Song Q. Prognostic nomogram for predicting survival in patients with high grade endometrial stromal sarcoma: a Surveillance Epidemiology, and End Results database analysis. Int J Gynecol Cancer 2020; 30:1520-1527. [PMID: 32839227 DOI: 10.1136/ijgc-2020-001409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE High grade endometrial stromal sarcoma is a rare and highly malignant tumor that lacks a prognostic model. The aim of this study was to develop a prognostic nomogram predicting the overall survival of patients with high grade endometrial stromal sarcoma. METHODS Clinical data for patients were derived from the Surveillance Epidemiology, and End Results database. Cox analysis and Akaike's information criterion were used to construct the nomogram. The concordance index, time dependent receiver operating characteristic curve, and calibration plot were used to evaluate the discriminative and calibrating capability. The net reclassification index, integrated discrimination improvement, and concordance index change were also compared between the nomogram and the International Federation of Gynecology and Obstetrics (FIGO) stage. Clinical benefit was evaluated using decision curve analysis. The patients were separated into groups with low and high nomogram risk scores. Kaplan-Meier curve analysis and Cox analysis were used to investigate the survival difference between the two groups. RESULTS The training and validation cohorts had 461 and 195 patients, respectively. A nomogram that incorporated disease stage, age, surgery, lymph node status, radiotherapy, and chemotherapy for predicting overall survival was established and validated. The concordance index of the nomogram was 0.734 (0.708-0.761) in the training cohort and 0.705 (0.659-0.751) in the validation cohort. The calibration plots showed a favorable calibrating ability of the nomogram. The 1 year and 3 year time dependent receiver operating characteristic curves showed the better discriminative ability of the nomogram than the staging system. The concordance index change, net reclassification index, and integrated discrimination improvement also indicated a significantly (p<0.05) better predictive power of the nomogram over disease stage. Furthermore, decision curve analysis suggested that the nomogram was clinically useful and had a larger clinical net benefit than disease stage alone. Patients with a high risk score had distinctly poorer survival than those with low risk scores. CONCLUSIONS A prognostic nomogram in patients with high grade endometrial stromal sarcoma exhibited favorable prognostic discrimination and survival prediction ability compared with FIGO stage.
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Affiliation(s)
- Jie Wu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Huibo Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Lan Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Mengxue Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Liang Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Siyi Wu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Bin Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China .,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China .,Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, Hubei, China
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Shushkevich A, Thaker PH, Littell RD, Shah NA, Chiang S, Thornton K, Hensley ML, Slomovitz BM, Holcomb KM, Leitao MM, Toboni MD, Powell MA, Levine DA, Dowdy SC, Klopp A, Brown J. State of the science: Uterine sarcomas: From pathology to practice. Gynecol Oncol 2020; 159:3-7. [PMID: 32839026 DOI: 10.1016/j.ygyno.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, United States
| | - Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA, United States
| | | | - Sarah Chiang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Martee L Hensley
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Kevin M Holcomb
- Weill Cornell Medical College at New York-Presbyterian Hospital, New York, NY, United States
| | - Mario M Leitao
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michael D Toboni
- Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States
| | - Douglas A Levine
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States
| | | | - Ann Klopp
- The University of Texas M.D., Anderson Cancer Center, Houston, TX, United States
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States.
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20
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Wu J, Zhang H, Li L, Hu M, Chen L, Xu B, Song Q. A nomogram for predicting overall survival in patients with low-grade endometrial stromal sarcoma: A population-based analysis. Cancer Commun (Lond) 2020; 40:301-312. [PMID: 32558385 PMCID: PMC7365459 DOI: 10.1002/cac2.12067] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/08/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Jie Wu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Huibo Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Lan Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Mengxue Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Liang Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Bin Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, P. R. China
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Nasioudis D, Mastroyannis SA, Latif NA, Ko EM, Haggerty AF, Kim SH, Morgan MA, Giuntoli RL. Effect of bilateral salpingo-oophorectomy on the overall survival of premenopausal patients with stage I low-grade endometrial stromal sarcoma; a National Cancer Database analysis. Gynecol Oncol 2020; 157:634-638. [DOI: 10.1016/j.ygyno.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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Mayo-de-Las-Casas C, Velasco A, Sanchez D, Martínez-Bueno A, Garzón-Ibáñez M, Gatius S, Ruiz-Miró M, Gonzalez-Tallada X, Llordella I, Tresserra F, Rodríguez S, Aldeguer E, Roman-Canal B, Bertran-Alamillo J, García-Peláez B, Rosell R, Molina-Vila MA, Matias-Guiu X. Detection of somatic mutations in peritoneal lavages and plasma of endometrial cancer patients: A proof-of-concept study. Int J Cancer 2020; 147:277-284. [PMID: 31953839 DOI: 10.1002/ijc.32872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Although most patients are diagnosed at early stages, 15-20% will relapse despite local treatment. Presently, there are no reliable markers to identify patients with worse outcomes who may benefit from adjuvant treatments, such as chemotherapy, and liquid biopsies may be of use in this setting. Peritoneal lavages are systematically performed during endometrial surgery but little data are available about their potential as liquid biopsies. We analyzed KRAS and PIK3CA mutations in paired surgical biopsies, blood and cytology-negative peritoneal lavages in a cohort of 50 EC patients. Surgical biopsies were submitted to next-generation sequencing (NGS) while circulating-free DNA (cfDNA) purified from plasma and peritoneal lavages was analyzed for KRAS and PIK3CA hotspot mutations using a sensitive quantitative polymerase chain reaction (PCR) assay. NGS of biopsies revealed KRAS, PIK3CA or concomitant KRAS + PIK3CA mutations in 33/50 (66%) EC patients. Of those, 19 cases carried hotspot mutations. Quantitative PCR revealed KRAS and/or PIK3CA mutations in the lavages of 9/19 (47.4%) hotspot EC patients. In contrast, only 2/19 (10.5%) blood samples from hotspot EC patients were positive. Mutations found in cfDNA consistently matched those in paired biopsies. One of the two patients positive in plasma and lavage died in less than 6 months. In conclusion, mutational analysis in peritoneal lavages and blood from early stage EC is feasible. Further studies are warranted to determine if it might help to identify patients with worse prognosis. Human genes discussed: KRAS, KRAS proto-oncogene, GTPase; PIK3CA, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha.
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Affiliation(s)
- Clara Mayo-de-Las-Casas
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Ana Velasco
- Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Douglas Sanchez
- Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | | | - Mónica Garzón-Ibáñez
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Sònia Gatius
- Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | | | | | - Ivana Llordella
- Department of Gynecology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Francesc Tresserra
- Department of Pathology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Sonia Rodríguez
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Erika Aldeguer
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | | | - Jordi Bertran-Alamillo
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Beatriz García-Peláez
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Rafael Rosell
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital, Badalona, Spain
| | - Miguel A Molina-Vila
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
- Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
- University of Lleida, CIBERONC, Lleida, Spain
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Zhang Y, Li N, Wang W, Yao H, An J, Li N, Sun Y, Wu L. Long-term impact of lymphadenectomies in patients with low-grade, early-stage uterine endometrial stroma sarcoma. J Obstet Gynaecol Res 2020; 46:654-662. [PMID: 32022392 DOI: 10.1111/jog.14198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
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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Affiliation(s)
- Yuanyuan Zhang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenpeng Wang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jusheng An
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangchun Sun
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Nasioudis D, Ko EM, Kolovos G, Vagios S, Kalliouris D, Giuntoli RL. Ovarian preservation for low-grade endometrial stromal sarcoma: a systematic review of the literature and meta-analysis. Int J Gynecol Cancer 2020; 29:126-132. [PMID: 30640694 DOI: 10.1136/ijgc-2018-000063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of ovarian preservation on oncologic outcomes for women with low-grade endometrial stromal sarcoma of the uterus. METHODS A systematic search of the Medline, Embase, Cohrane, and Web of Science databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies including patients with low-grade endometrial stromal sarcoma who had hysterectomy were identified. Data on tumor recurrence and death rate were pooled using a random effects model. RESULTS A total of 17 studies met the inclusion criteria and reported on 786 patients. Based on available information, ovarian preservation was noted in 190 patients while 501 had bilateral salpingo-oophorectomy. A significantly increased tumor recurrence rate was observed in the ovarian preservation group (89/190, 46.8%) compared with the bilateral salpingo-oophorectomy group (121/501, 24.2%) (OR 2.70, 95% CI 1.39 to 5.28). Based on data from 162 patients, no difference in death rate was noted between the ovarian preservation (2/34, 5.9%) and bilateral salpingo-oophorectomy (9/128, 7%) groups (OR 0.80, 95% CI 0.18 to 3.47). CONCLUSIONS Approximately one-quarter of patients with low-grade endometrial stromal sarcoma were managed with ovarian preservation. These women experienced a higher recurrence rate. Hormone exposure may be responsible for this elevated risk. Given the apparent high salvage rate, however, ovarian preservation may be an option only in a well-informed patient population.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA .,Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Georgios Kolovos
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Stylianos Vagios
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Dimitrios Kalliouris
- Surgery Working Group, Obstetrics and Gynecology Subgroup, Society of Junior Doctors, Athens, Greece
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Pannier D, Cordoba A, Ryckewaert T, Robin YM, Penel N. Hormonal therapies in uterine sarcomas, aggressive angiomyxoma, and desmoid-type fibromatosis. Crit Rev Oncol Hematol 2019; 143:62-66. [DOI: 10.1016/j.critrevonc.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
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The clinical benefits of hormonal treatment for LG-ESS: a meta-analysis. Arch Gynecol Obstet 2019; 300:1167-1175. [PMID: 31583462 DOI: 10.1007/s00404-019-05308-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/14/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the clinical benefits of hormonal treatment for patients with low-grade endometrial stromal sarcoma (LG-ESS) by reviewing the published literature and performing a meta-analysis. METHODS Correlational studies related to hormonal treatment for LG-ESS patients were collected by searching the PubMed, EMBASE, and Cochrane databases up to December 2018. Eligible studies were selected based on inclusion and exclusion criteria. The main inclusion criteria included: original studies with definite diagnoses of LG-ESS that evaluated the clinical benefits of hormonal treatment, studies with at least 10 cases, and studies published in English. Reviews, case reports, letters, comments or conference abstracts, studies without sufficient data and overlapping or republished studies were excluded. The study quality was evaluated, and pooled relative risks and 95% confidence intervals were calculated using Review Manager 5.3. RESULTS A total of 10 retrospective studies were included. The NOS stars of the 10 studies ranged from 7 to 9 points, which was considered to be of high quality. Recurrence and death information was provided in 9 and 6 studies, respectively. The overall pooled RR for recurrence was 0.66 (95% CI 0.47-0.94), which indicated that hormonal treatment was effective at reducing the recurrence risk (P = 0.02). The overall pooled RR for death was 0.81 (95% CI 0.59-1.12), which showed that hormonal treatment had little effect in prolonging overall survival (P = 0.20). Stratified analysis showed that compared with the group without any adjuvant treatments, hormonal treatment alone significantly decreased the risk of recurrence (P = 0.02), while hormonal treatment had no significant effects on overall survival (P = 0.38). Another subgroup analysis indicated that for stage I-II patients, hormonal treatment could significantly decrease the risk of recurrence (P = 0.02) but could not influence overall survival (P = 0.87). However, for stage III-IV patients, hormonal treatment had little benefit both in reducing the recurrence risk and prolonging overall survival (P = 0.49/0.08). Egger's and Begg's test showed that the publication bias for the literature was satisfactorily controlled. CONCLUSION Adjuvant hormonal treatment should be considered as a feasible adjuvant therapy for reducing the recurrence risk of patients with LG-ESS while bearing little benefit on overall survival.
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Deshmukh U, Black J, Perez-Irizarry J, Passarelli R, Levy K, Rostkowski A, Hui P, Rutherford TJ, Santin AD, Azodi M, Silasi DA, Ratner E, Litkouhi B, Schwartz PE. Adjuvant Hormonal Therapy for Low-Grade Endometrial Stromal Sarcoma. Reprod Sci 2018; 26:600-608. [DOI: 10.1177/1933719118778801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Uma Deshmukh
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Javier Perez-Irizarry
- Yale-New Haven Hospital-Smilow Cancer Center Tumor Registry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Karen Levy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Amanda Rostkowski
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas J. Rutherford
- College of Medicine Obstetrics & Gynecology, University of South Florida, Tampa, FL, USA
| | - Alessandro D. Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Peter E. Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Impact of oophorectomy and hormone suppression in low grade endometrial stromal sarcoma: A multicenter review. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nasioudis D, Chapman-Davis E, Frey M, Holcomb K. Safety of ovarian preservation in premenopausal women with stage I uterine sarcoma. J Gynecol Oncol 2018; 28:e46. [PMID: 28541635 PMCID: PMC5447146 DOI: 10.3802/jgo.2017.28.e46] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/07/2017] [Accepted: 03/12/2017] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the oncologic safety of ovarian preservation (OP) in premenopausal women diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) stage I uterine sarcoma. Methods The National Cancer Institute's Surveillance, Epidemiology, and End Results database was accessed and a cohort of women aged ≤50 diagnosed between 1988–2013 with a sarcoma limited to the uterus was drawn. Based on site-specific surgery codes, women who underwent hysterectomy with or without oophorectomy and did not receive radiation therapy were selected for further analysis. Overall (OS) and cancer-specific (CSS) survival were determined following generation of Kaplan-Meier curves; comparisons were made with the log-rank test. A Cox-proportional hazard model was constructed to control for possible confounders. Results A total of 1,482 women were included in the analysis; 800 (54.0%) were diagnosed with leiomyosarcoma (LMS), 520 (35.1%) with low-grade endometrial stromal sarcoma (LG-ESS), and 162 (10.9%) with adenosarcoma (AS). The OP group included 418 women (28.2%). Differences in the rate of OP were noted based on histology (p=0.014), year of diagnosis (p=0.001), patient age (p<0.001) and race (p=0.012). There was no difference in OS (p=0.220) or CSS (p=0.210) between women who had OP and those who did not. Multivariate analysis confirmed that OP was not associated with a worse mortality. Conclusion In this population-based cohort of women with sarcoma limited to the uterus, OP was not associated with worse oncologic outcomes. OP could be considered for women with LMS, sparing them from the morbidity associated with iatrogenic menopause. No conclusions could be made for those with LG-ESS or AS.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Melissa Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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Bužinskienė D, Mikėnas S, Drąsutienė G, Mongirdas M. Uterine sarcoma: a clinical case and a literature review. Acta Med Litu 2018; 25:206-218. [PMID: 31308826 PMCID: PMC6591694 DOI: 10.6001/actamedica.v25i4.3931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/05/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Uterine sarcomas are rare gynaecologic tumours representing 3-7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. MATERIALS AND METHODS We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. RESULTS AND CONCLUSIONS Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3-7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.
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Affiliation(s)
- Diana Bužinskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Saulius Mikėnas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Centre of Urology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Urology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gražina Drąsutienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Lou T, Yuan F, Feng Y, Wang S, Bai H, Zhang Z. The safety of fertility and ipsilateral ovary procedures for borderline ovarian tumors. Oncotarget 2017; 8:115718-115729. [PMID: 29383195 PMCID: PMC5777807 DOI: 10.18632/oncotarget.23021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the optimal treatment options for women with borderline ovarian tumors (BOTs). Materials and Methods The medical records of consecutive patients with BOTs in two academic institutions were retrospectively collected. The pertinent data, including clinicopathological characteristics and, treatment and prognostic information were evaluated. Results A total of 281 cases of BOTs were included in this analysis. For the entire series, the 5- year disease-free survival (DFS) and overall survival (OS) rates were 91.8% and 98.5%, respectively. In the multivariate analysis, reservation of the ipsilateral ovary (HR: 0.104 [95% CI, 0.036–0.304], p = 0.000) and FIGO stage II–III (HR: 6.811 [95% CI, 2.700–17.181], p = 0.000) were the independent risk factors for recurrence. Ovarian surface involvement (HR: 64.996 [95% CI, 4.054–1041.941], p = 0.003) was the only independent prognostic factor for OS. Lymphadenectomy and adjunct chemotherapy had no significant impact on patients’ recurrence and survival (recurrence: p = 0.332 and 0.290, respectively, survival: p = 0.896 and 0.216, respectively). Conclusions Fertility-sparing surgery with healthy ovarian preservation seems safe and feasible for young women who prefer fertility-sparing treatment. Ovarian cystectomy to conserve the affected ovary/ovaries without ovarian surface involvement may be cautiously performed under fully informed consent for young women with bilateral BOTs who strongly prefer fertility-sparing treatment and have no evidence of infertility. However, long-term follow-up is necessary due to the relapse susceptibility of the ovary.
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Affiliation(s)
- Tong Lou
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the affiliated hospital of Qingdao University, Qingdao, China
| | - Ying Feng
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuzhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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18F-FDG/18F-FES standardized uptake value ratio determined using PET predicts prognosis in uterine sarcoma. Oncotarget 2017; 8:22581-22589. [PMID: 28186981 PMCID: PMC5410246 DOI: 10.18632/oncotarget.15127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/29/2017] [Indexed: 11/25/2022] Open
Abstract
We investigated whether 16α-[18F]-fluoro-17β-estradiol (18F-FES) and 18F-fluoro-deoxyglucose (FDG) uptake measured using positron emission tomography (PET) predicted prognosis in 18 patients with different histological subtypes of uterine sarcoma. Standardized uptake values (SUVs) and 18F-FDG/18F-FES SUV ratios were determined, and their correlations with progression-free (PFS) and overall survival (OS) were examined. Ten patients died from local recurrence or metastasis, and one more experienced recurrence, during the at least 36-month follow-up period. Patients with higher 18F-FDG SUVs (> 5.5) had worse OS (p = 0.007) and tended toward worse PFS (p = 0.11), while patients with lower 18F-FES SUVs (≤ 1.5) had worse PFS (p = 0.03) and tended toward worse OS (p = 0.19). Patients with 18F-FDG/18F-FES ratios > 2.6 had worse PFS (p = 0.009) and OS (p = 0.005). The 5-year PFS and OS rates were 75% and 88% for patients with lower ratios, but were only 10% and 20% for those with higher ratios. These results suggest that pretreatment tumor 18F-FDG/18F-FES ratio is useful for predicting the prognosis of uterine sarcoma patients.
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Agarwal R, Rajanbabu A, Nair IR, Satish C, Jose G, Unikrishnan U. Endometrial stromal sarcoma—A retropsective analysis of factors affecting recurrence. Eur J Obstet Gynecol Reprod Biol 2017; 216:92-97. [DOI: 10.1016/j.ejogrb.2017.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 12/01/2022]
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Endometrial Stromal Sarcoma Arising from Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The malignant transformation of endometriosis is a very uncommon event but can occur in 0.7% to 1% of all cases. Any histological type of tumor found in the endometrium might also occur in endometriosis. Most malignant tumors that originate from endometriosis are endometrioid adenocarcinomas and also clear-cell type carcinomas. On the other hand, sarcomas, especially endometrial stromal sarcoma (ESS), are extremely unusual representing 12% of all cases. ESS is an uncommon neoplasm and accounts for 0.2% of the uterine malignances. Malignant tumors arising from endometriosis can derive from the uterine wall as well as from extra-uterine sites. The most frequent extrauterine location is the ovary (78.7%), followed by the pelvic peritoneum (5.7%), the rectovaginal septum (4.3%), the colon (4.3%) and the vagina (2%), representing the majority of extragonadal sites. ESSs arising from the extrauterine and extraovarian endometriosis sites in the absence of a primary uterine lesion are extremely rare and the treatment options are not clear. Surgical debulking seems to be the best treatment. Adjuvant therapy, such as radiation, hormonal therapy and chemotherapy are not yet proven to be effective. Molecular target therapy could be a future possibility of treatment. A systematic review of English Medical Literature about incidence, treatment and prognosis of extrauterine ESS arising from endometriosis foci was performed. The selected articles on which this review is based are the following: 9 literature reviews, 8 retrospective studies, 7 case series, 1 prospective trial and 11 case reports.
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Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation. Int J Gynecol Cancer 2016; 26:456-63. [DOI: 10.1097/igc.0000000000000638] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Chen S, Sun KX, Liu BL, Zong ZH, Zhao Y. MicroRNA-505 functions as a tumor suppressor in endometrial cancer by targeting TGF-α. Mol Cancer 2016; 15:11. [PMID: 26832151 PMCID: PMC4736705 DOI: 10.1186/s12943-016-0496-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/27/2016] [Indexed: 02/06/2023] Open
Abstract
Background Endometrial carcinoma (EC) is one of the most lethal gynecologic cancers. Patients frequently have regional or distant metastasis at diagnosis. MicroRNAs are small non-coding RNAs that participate in numerous biological processes. Recent studies have demonstrated that miR-505 is associated with several types of cancer; however, the expression and function of miR-505 have not been investigated in EC. Methods miR-505 expression in normal endometrial tissue, endometrial carcinomas were quantified by Quantitative reverse transcription PCR. The endometrial carcinoma cell lines HEC-1B and Ishikawa were each transfected with miR-505 or scrambled mimics, after which cell phenotype and expression of relevant molecules were assayed. Dual-luciferase reporter assay and a xenograft mouse model were used to examine miR-505 and its target gene TGF-α. Results RT-PCR results demonstrated that miR-505 was significantly downregulated in human EC tissues compared to normal endometrial tissues. Besides, miR-505 expression was negatively associated with FIGO stage (stage I-II vs. III-IV), and lymph node metastasis (negative vs. positive). In vitro, overexpression of miR-505 significantly suppressed EC cell proliferation, increased apoptosis and reduced migratory and invasive activity. A miR-505 binding site was identified in the 3′ untranslated region of TGF-α mRNA (TGFA) using miRNA target-detecting software; a dual luciferase reporter assay confirmed that miR-505 directly targets and regulates TGFA. RT-PCR and Western-blotting results indicated that overexpressing miR-505 reduced the expression of TGF-α and the TGF-α-regulated proteins MMP2, MMP9, CDK2, while induced Bax and cleaved-PARP expression in EC cells. In vivo, overexpression of miR-505 reduced the tumorigenicity and inhibited the growth of xenograft tumors in a mouse model of EC. Conclusions Taken together, this study demonstrates that miR-505 acts as tumor suppressor in EC by regulating TGF-α. Electronic supplementary material The online version of this article (doi:10.1186/s12943-016-0496-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuo Chen
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Kai-Xuan Sun
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Bo-Liang Liu
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Zhi-Hong Zong
- Department of Biochemistry and Molecular Biology, College of Basic Medicine, China Medical University, Shenyang, 100013, China
| | - Yang Zhao
- Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
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Abstract
ObjectiveUterine sarcomas are rare, highly aggressive tumors with an unfavorable prognosis. The role of lymphadenectomy (LAD) remains controversial for this particular tumor type. To examine whether LAD can assist in prognosis or clinical benefits for uterine sarcoma patients, we performed a meta-analysis based on published studies.MethodsWe initially identified published studies by searching the PubMed database up to 30 November 2015. Study quality was evaluated systematically using the Newcastle-Ottawa Scale for assessing the quality of studies for inclusion in meta-analyses. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using Stata software version 12.0.ResultsOur search retrieved 14 eligible studies, involving a total of 4867 patients, including 1356 (27.9%) patients who had LAD. The pooled RR for uterine leiomyosarcoma (uLMS) in patients with LAD in 5 trials was 0.90 (95% CI, 0.62–1.31) and for endometrial stromal sarcoma (ESS) in 11 trials was 0.96 (95% CI, 0.69–1.34), suggesting that there was no significant benefit of LAD in improving overall survival (P < 0.05). A random-effects model was chosen to estimate the RRs in view of the significant heterogeneity in the included studies (uLMS: Cochran Q test: P = 0.022, I2 = 64.9%; ESS: Cochran Q test: P = 0.005, I2 = 60.1%). No publication bias was detected by the Egger and Begg tests (uLMS: Begg: P = 0.221, Egger: P = 0.148; ESS: Begg: P = 1.000, Egger: P = 0.928).ConclusionsBased on currently available evidence, the findings of this meta-analysis suggest that LAD bears little prognostic or therapeutic benefit in patients with uterine sarcoma. Systematic LAD may not be recommended in patients with uLMS or ESS unless the patient has obvious extrauterine involvement, clinically suspicious enlarged nodes, or advanced sarcomas.
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Lv Y, Wang N, Liu Y, Li X, Fan L, Li M, Wang L, Yu Z, Yan Q, Guo Y, Guo S, Wei L, Shi M, Wang Z. Tumor invasion depth is a useful pathologic assessment for predicting outcomes in cervical squamous cell carcinoma after neoadjuvant radiotherapy. Diagn Pathol 2015; 10:200. [PMID: 26537362 PMCID: PMC4632273 DOI: 10.1186/s13000-015-0426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background To evaluate whether tumor invasion depth can be a reliable and easily applicable pathologic assessment strategy to predict outcomes using surgically resected cervical squamous cell carcinoma specimens from patients who have received neoadjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Methods We included 173 patients with cervical squamous cell carcinoma who received neoadjuvant CCRT (n = 125) or RT (n = 48) and underwent subsequent radical hysterectomy. Data for the pre-operative clinical International Federation of Gynecology and Obstetrics (FIGO) stage, post-operative pathologic FIGO stage, World Health Organization (WHO) double diameter measurement evaluation, response evaluation criteria in solid tumors (RECIST 1.1) criteria, tumor necrosis rate (TNR), and tumor regression grade (TRG) were investigated to identify correlations with outcomes related to distant metastasis and survival. The tumor invasion depth (TID) and the tumor invasion depth with cytokeratin immunostaining correction (TIDC) at the cervical internal surface were measured to assess their relations to patients’ outcomes. Results Based on measurements taken via transvaginal ultrasound, the pre-operative clinical and post-operative pathologic FIGO staging as well as the WHO double diameter measurement evaluation and RECIST 1.1 criteria were predictive of distant metastasis and survival-related outcomes. Also, lymph node involvement was found to be an independent prognostic factor for recurrence and distant metastasis. Finally, univariate analysis showed both the TID and TIDC were highly related to distant metastasis, overall survival, and progression-free survival, irrespective of the clinical stage of carcinomas. Conclusion The TID or TIDC measured at the cervical internal surface is a useful and easily applied pathologic prognostic factor for distant metastasis and survival outcomes in patients with cervical squamous cell carcinoma treated with neoadjuvant RT or CCRT. Electronic supplementary material The online version of this article (doi:10.1186/s13000-015-0426-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yang Lv
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Ning Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Yixiong Liu
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Xia Li
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Linni Fan
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Mingyang Li
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Lu Wang
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Zhou Yu
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Qingguo Yan
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Ying Guo
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Shuangping Guo
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
| | - Zhe Wang
- State Key Laboratory of Cancer Biology, Department of Pathology Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, P.R. China.
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Potential Therapeutic Targets in Uterine Sarcomas. Sarcoma 2015; 2015:243298. [PMID: 26576131 PMCID: PMC4632006 DOI: 10.1155/2015/243298] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Abstract
Uterine sarcomas are rare tumors accounting for 3,4% of all uterine cancers. Even after radical hysterectomy, most patients relapse or present with distant metastases. The very limited clinical benefit of adjuvant cytotoxic treatments is reflected by high mortality rates, emphasizing the need for new treatment strategies. This review summarizes rising potential targets in four distinct subtypes of uterine sarcomas: leiomyosarcoma, low-grade and high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. Based on clinical reports, promising approaches for uterine leiomyosarcoma patients include inhibition of VEGF and mTOR signaling, preferably in combination with other targeted or cytotoxic compounds. Currently, the only targeted therapy approved in leiomyosarcoma patients is pazopanib, a multitargeted inhibitor blocking VEGFR, PDGFR, FGFR, and c-KIT. Additionally, preclinical evidence suggests effect of the inhibition of histone deacetylases, tyrosine kinase receptors, and the mitotic checkpoint protein aurora kinase A. In low-grade endometrial stromal sarcomas, antihormonal therapies including aromatase inhibitors and progestins have proven activity. Other potential targets are PDGFR, VEGFR, and histone deacetylases. In high-grade ESS that carry the YWHAE/FAM22A/B fusion gene, the generated 14-3-3 oncoprotein is a putative target, next to c-KIT and the Wnt pathway. The observation of heterogeneity within uterine sarcoma subtypes warrants a personalized treatment approach.
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Wolfe H, Bunch K, Stany M. Prolonged response to exemestane following multiple surgical resections and hormonal therapies in a patient with recurrent endometrial stromal sarcoma. Gynecol Oncol Rep 2015; 15:4-6. [PMID: 26937477 PMCID: PMC4750016 DOI: 10.1016/j.gore.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 12/28/2022] Open
Abstract
Background Endometrial stromal sarcomas (ESSs) are rare, indolent tumors with high recurrence rates. Management includes surgery and hormonal therapy given high estrogen and progesterone receptor (ER/PR) expression. Case A pre-menopausal patient with stage II ESSs (ER +/PR +) underwent primary surgery followed by adjuvant megestrol. Recurrence in the bladder/upper vagina (ER +/PR −) was diagnosed one year later and treated with anterior pelvic exenteration and adjuvant letrozole. Two years later she recurred and was treated with radical surgery and adjuvant exemestane therapy (tumor ER strongly +/PR +). The patient then had a five-year disease free interval before being diagnosed with her third recurrence (ER +). Conclusion Exemestane treatment for ESSs can lead to a prolonged response, even in the setting of progression after prior aromatase inhibitor treatment. Aromatase inhibitors (AIs) are used in the treatment of endometrial stromal sarcoma. Letrozole and anastrozole are type 2 reversible nonsteroidal AIs. Exemestane is a type 1 irreversible steroidal AI. Exemestane demonstrated a prolonged clinical response and is well-tolerated.
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Affiliation(s)
- Heather Wolfe
- Walter Reed National Military Medical Center,Department of Obstetrics and Gynecology, United States
| | - Kristen Bunch
- Walter Reed National Military Medical Center,Department of Obstetrics and Gynecology,Division of Gynecologic Oncology, United States
| | - Michael Stany
- Walter Reed National Military Medical Center,Department of Obstetrics and Gynecology,Division of Gynecologic Oncology, United States
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Yamazaki H, Todo Y, Mitsube K, Hareyama H, Shimada C, Kato H, Yamashiro K. Long-term survival of patients with recurrent endometrial stromal sarcoma: a multicenter, observational study. J Gynecol Oncol 2015; 26:214-21. [PMID: 25925291 PMCID: PMC4510338 DOI: 10.3802/jgo.2015.26.3.214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 02/03/2023] Open
Abstract
Objective The aim of this study was to evaluate the clinical behavior and management outcome of recurrent endometrial stromal sarcoma (ESS). Methods A retrospective review of charts of 10 patients with recurrent ESS was performed and relapse-free interval, relapse site, treatment, response to treatment, duration of follow-up and clinical outcome extracted. Survival outcome measures used were post-relapse survival which was defined as the time from first evidence of relapse to death from any cause. Living patients were censored at the date of last follow-up. Results The median age and median relapse-free interval at the time of initial relapse were 51.5 years and 66.5 months, respectively. The number of relapses ranged from one to five. Sixteen surgical procedures for recurrent disease included nine (56.0%) complete resections. There was no statistically significant difference between initial recurrent tumors and second/subsequent recurrent tumors in the rate of complete surgery (44.4% vs. 71.4%, respectively, p=0.36). Of the eleven evaluable occasions when hormonal therapy was used for recurrent disease, disease control was achieved in eight (72.7%). There was no difference between initial recurrent tumors and second/subsequent recurrent tumors in disease control rate by hormonal therapy (85.7% vs. 50.0%, respectively, p=0.49). The 10-year post-relapse survival rate was 90.0% and the overall median post-relapse survival 119 months (range, 7 to 216 months). Conclusion Post-relapse survival of patients with ESS can be expected to be >10 years when treated by repeated surgical resection and hormonal therapy or both.
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Affiliation(s)
- Hiroyuki Yamazaki
- Division of Gynecologic Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan.
| | - Kenrokuro Mitsube
- Division of Obstetrics and Gynecology, Asahikawa Kosei General Hospital, Asahikawa, Japan
| | - Hitoshi Hareyama
- Division of Obstetrics and Gynecology, Sapporo Municipal Hospital, Sapporo, Japan
| | - Chisa Shimada
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Katsushige Yamashiro
- Division of Pathology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
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Ali RH, Rouzbahman M. Endometrial stromal tumours revisited: an update based on the 2014 WHO classification. J Clin Pathol 2015; 68:325-32. [PMID: 25595274 DOI: 10.1136/jclinpath-2014-202829] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/20/2014] [Indexed: 12/26/2022]
Abstract
Endometrial stromal tumours (EST) are rare tumours of endometrial stromal origin that account for less than 2% of all uterine tumours. Recent cytogenetic and molecular advances in this area have improved our understanding of ESTs and helped refine their classification into more meaningful categories. Accordingly, the newly released 2014 WHO classification system recognises four categories: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS) and undifferentiated uterine sarcoma (UUS). At the molecular level, these tumours may demonstrate a relatively simple karyotype with a defining chromosomal rearrangement (as in the majority of ESNs, LGESSs and YWHAE-rearranged HGESS) or demonstrate complex cytogenetic aberrations lacking specific rearrangements (as in UUSs). Herein we provide an update on this topic aimed at the practicing pathologist.
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Affiliation(s)
- Rola H Ali
- Department of Clinical Pathology, Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait, Kuwait
| | - Marjan Rouzbahman
- Department of Anatomical Pathology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Complete remission achieved by oophorectomy for recurrent endometrial stromal sarcoma after laparoscopic morcellation. Gynecol Oncol Rep 2015; 11:1-3. [PMID: 26076082 PMCID: PMC4434162 DOI: 10.1016/j.gore.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/26/2014] [Indexed: 11/24/2022] Open
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Cade TJ, Quinn MA, Rome RM, Polyakov A. Prognostic significance of steroid receptor positivity and adjuvant progestogen use in endometrial stromal sarcoma. Aust N Z J Obstet Gynaecol 2014; 54:453-6. [DOI: 10.1111/ajo.12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas J. Cade
- Department of Obstetrics and Gynaecology; Royal Women's Hospital; Parkville Victoria Australia
| | - Michael A. Quinn
- Department of Obstetrics and Gynaecology; Royal Women's Hospital; Parkville Victoria Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Parkville Victoria Australia
| | - Robert M. Rome
- Department of Obstetrics and Gynaecology; Royal Women's Hospital; Parkville Victoria Australia
- Obstetrics and Gynaecology Institute; Epworth Freemasons Hospital; Melbourne Victoria Australia
| | - Alexander Polyakov
- Department of Obstetrics and Gynaecology; Royal Women's Hospital; Parkville Victoria Australia
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Clinical characteristics, pathological reevaluation, surgical management and adjuvant therapy of patients with endometrial stromal tumors. Arch Gynecol Obstet 2014; 290:1195-200. [DOI: 10.1007/s00404-014-3320-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
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