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Survival outcomes and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma

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Abstract

Purpose

To review the diagnostic and therapeutic procedures of patients diagnosed with Endometrial Stromal Sarcoma (ESS) and Undifferentiated Uterine Sarcoma (USS) at our institution and investigate their clinical outcomes and factors affecting prognosis.

Methods

We retrospectively collected demographic data, preoperative diagnostic methods and therapeutic management of patients treated for ESS and UUS between January 1995 and December 2019 at Vall d’Hebron Barcelona Hospital Campus, Spain. Overall survival and disease-free survival were calculated. Cox proportional-hazards regression models were calculated.

Results

Sixty-three patients were included in the study, of which 51(81%) had a diagnosis of ESS and 12(19%) of UUS. Twenty patients (31.7%) were diagnosed after a previous non-oncologic surgery, and 12 of them (60%) suffered from tumor disruption. Cytoreductive procedures were needed in 29 patients (46%), and optimal cytoreduction was achieved in 80.9% of the patients. The median follow-up was 7.6 years (IQR = 0.99–14.31). Five-year overall survival was 57.6% (44.2–68.8) and was significantly better for low-grade ESS (LG-ESS) patients (p < 0.01). Five-year disease-free survival was 57.1% (42.8–69.1) and was also significantly higher in LG-ESS cohort (p = 0.03). After multivariate analysis histological type, age, FIGO stage, optimal surgery and mitotic index were found significantly correlated with survival. For high-grade EES (HG-ESS) and USS patients adjuvant radiotherapy also correlated with improved survival.

Conclusion

Overall survival and disease-free survival are significantly better in patients with LG-ESS cohort. HG-ESS and UUS show similar survival outcomes. Age, FIGO stage, optimal surgery and histological type were significantly correlated with survival in the global cohort, whilst adjuvant radiotherapy correlated with improved survival in HG-ESS and UUS patients.

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Funding

The present work was not supported by any grant or organization.

Author information

Authors and Affiliations

  1. Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    S. Cabrera, V. Bebia & S. Franco-Camps

  2. Universitat Autònoma de Barcelona, Bellaterra, Spain

    S. Cabrera, A. García-Jiménez & A. Gil-Moreno

  3. Gynecology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

    U. Acosta, L. Mañalich & A. Gil-Moreno

  4. Pathology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

    A. García-Jiménez

Authors
  1. S. Cabrera
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  2. V. Bebia
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  4. S. Franco-Camps
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  5. L. Mañalich
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  7. A. Gil-Moreno
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Contributions

S. Cabrera is the principal investigator, designed the study, reviewed the literature, collected and analyzed data, and wrote the paper. V. Bebia, S. Franco-Camps, L. Mañalich and U. Acosta contributed to the collection of data, critical revision of the manuscript, and read and approved the final draft here uploaded. V. Bebia performed the statistical analyses. A. Gil-Moreno and A. García-Jimenez reviewed the manuscript for intellectual and scientific content, and approved the final draft.

Corresponding author

Correspondence to S. Cabrera.

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Data of this work are available under justified request to the corresponding author.

Conflicts of interest

The authors state that they have neither financial nor personal relationships with any organization that could inappropriately influence the present work.

Ethics approval

The present research was submitted and approved by Vall d’Hebron Ethics Committee (Project Code PR(AMI)526/2019) on date Dec 11th, 2019.

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Not applicable regarding the decision made by Ethics Committee.

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Cabrera, S., Bebia, V., Acosta, U. et al. Survival outcomes and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma. Clin Transl Oncol 23, 1210–1219 (2021). https://doi.org/10.1007/s12094-020-02512-6

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  • DOI: https://doi.org/10.1007/s12094-020-02512-6

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