Abstract:
AIMS:Endometrial stromal sarcoma (ESS) has traditionally been divided into low and high grade, but the World Health Organization (WHO, 2003) has changed the definition. Since 2003, many studies have used the old criteria, and few have focused on WHO 2003-defined ESS low grade (ESS-LG). The aim of this study was to investigate prognosticators in ESS-LG. METHODS AND RESULTS:We reviewed the WHO 2003 diagnostic criteria in 91 tumours (previously classified as ESS low and high grade). There were 68 cases of ESS-LG and 23 of undifferentiated endometrial sarcoma (UES). In the ESS-LG cases, the prognostic value of clinicopathological variables was studied. With a median follow-up of 79 months (range: 20-474 months), the recurrence and death rates were 5/68 (7%) and 1/68 (1.5%) in the ESS-LG cases. Ovarian preservation or no ovarian preservation (P < 0.0001, hazard ratio (HR) 10.4) and mitotic activity index (MAI) (0-3 versus >3, P = 0.005, HR 8.6) had independent prognostic value. Other frequently used MAI thresholds - age, tumour diameter, and vessel invasion - were not prognostic. Among patients without ovarian preservation (n = 61), none of 53 with MAI 0-3 suffered recurrence, contrasting with two of eight (25%) of those with MAI >3 (P = 0.003); one of these two recurrence patients died (P = 0.02). Among patients with ovarian preservation (n = 7), three (43%) suffered recurrence but none died, and MAI had no additional prognostic value. CONCLUSIONS: In ESS-LG, ovarian preservation and MAI >3 are associated with increased risk of recurrence.
journal_name
Histopathologyjournal_title
Histopathologyauthors
Feng W,Hua K,Gudlaugsson E,Yu Y,Zhou X,Baak JPdoi
10.1111/j.1365-2559.2011.04115.xsubject
Has Abstractpub_date
2013-04-01 00:00:00pages
675-87issue
5eissn
0309-0167issn
1365-2559journal_volume
62pub_type
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