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Obstetrics & Gynecology 2005;106:1304-1308
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL ARTICLES

Ovarian Preservation in Stage I Low-Grade Endometrial Stromal Sarcomas

Andrew J. Li, MD1, Robert L. Giuntoli, II, MD2, Richard Drake, MD3, Sharon Young Byun, MD4, Francisco Rojas, MD2, Denise Barbuto, MD, PhD1, Nancy Klipfel, MD5, Pamela Edmonds, MD4, David S. Miller, MD3 and Beth Y. Karlan, MD1

From the 1Departments of Obstetrics/Gynecology and Pathology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California; 2Department of Obstetrics/Gynecology, Johns Hopkins Medical Institute, Baltimore, Maryland; 3Department of Obstetrics/Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; 4Departments of Obstetrics/Gynecology and Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and 5Department of Pathology, Keck School of Medicine at University of Southern California, Los Angeles, California.

OBJECTIVE: To examine the impact of ovarian preservation in a case-control study of women with stage I low-grade endometrial stromal sarcomas.

METHODS: Patients with low-grade endometrial stromal sarcomas were identified at 5 institutions from 1976 to 2002. Cases were defined as patients who retained ovarian function; each case was matched to 2 control patients who underwent bilateral salpingo-oophorectomy (BSO). Immunostaining for estrogen and progesterone receptors was performed. Data were examined with Student t, {chi}2, Cox regression, and Kaplan-Meier analyses.

RESULTS: Twelve premenopausal patients with low-grade endometrial stromal sarcomas who did not undergo BSO were matched to 24 controls. Of the 36 patients in the entire cohort, disease recurred in 14 (39%). Recurrences were identified in the pelvis, abdomen, lung, or lymphatics in both cases and controls. Disease recurred in 4/12 (33%) case patients, compared with 10/24 (42%) control patients (P = .63). When case patients were compared with controls, no differences in progression-free (91.3 months versus 68.6 months, P = .44) or overall survival (median survival not yet reached versus 406 months, P = .82) were identified. This study had 13% power to detect the observed difference in median disease-free survival. After controlling for use of adjuvant therapy and BSO, older age remained the only independent poor prognostic factor for progression-free survival (P = .008). Twenty-two available tumors demonstrated positivity for both estrogen and progesterone receptors.

CONCLUSION: Bilateral salpingo-oophorectomy did not appear to affect time to recurrence or overall survival. Retention of ovarian function may be an option for premenopausal women with low-grade endometrial stromal sarcomas.

LEVEL OF EVIDENCE: II-2






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