Comparative analysis of hormonal therapy in low-grade endometrial stromal sarcoma: A retrospective study

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2024-10-12 DOI:10.1016/j.ygyno.2024.10.008

Reem Saab , Bryan M. Fellman , Alejandra Flores Legarreta , Larissa A. Meyer , Nicole D. Fleming , Ravin Ratan , Elise F. Nassif Haddad , Michael Frumovitz , Pamela T. Soliman

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Abstract

Objective

To evaluate the disease course of patients with low grade endometrial stromal sarcoma (LG-ESS) and compare oncologic outcomes associated with hormonal therapy in primary and recurrent disease.

Methods

This is a retrospective study of patients with LG-ESS who underwent active treatment between January 2000 and July 2023. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier product-limit estimator and modeled via Cox proportional hazards regression.

Results

A total of 221 patients were included; 58 % of patients (91/157) were stage I, 12 % (19/157) stage II, 13 % (20/157) stage III, and 17 % (27/157) stage IV. Surgery was the primary treatment for 98 % (213/218). Only 79 patients received hormonal adjuvant therapy, 58 % (46/79) Megace, 24 % (19/79) Letrozole, and 18 % (14/79) received other hormonal therapy. There was no significant difference in RFS (p = 0.159) and OS (p = 0.167) between patients receiving Megace versus Letrozole as adjuvant therapy. At first recurrence, patients given Megace had a similar RFS to those on Letrozole (p = 0.302), but a better OS (27 vs 10 months, p = 0.018). Negative status of estrogen, smooth muscle actin, and desmin were associated with lower RFS (p = 0.039, p = 0.002, and p = 0.015, respectively) and OS (p = 0.008, p = 0.012, and p = 0.013, respectively). Lymphovascular invasion was associated with lower RFS (p = 0.033), and negative status of progesterone was associated with lower OS (p = 0.003).

Conclusion

There was no difference in oncologic outcomes between Megace and Letrozole in patients who received adjuvant therapy for LG-ESS. Megace may have potential survival advantage in recurrent disease. Further study is warranted to determine the most effective agents and their sequence in the treatment of LG-ESS.

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低级别子宫内膜间质肉瘤激素疗法的比较分析：回顾性研究

目的评估低级别子宫内膜间质肉瘤（LG-ESS）患者的病程，并比较原发性和复发性疾病中与激素治疗相关的肿瘤学结果。方法这是对2000年1月至2023年7月期间接受积极治疗的LG-ESS患者进行的一项回顾性研究。结果共纳入221例患者，其中58%（91/157）为I期，12%（19/157）为II期，13%（20/157）为III期，17%（27/157）为IV期。98%的患者（213/218）以手术为主要治疗手段。只有79名患者接受了激素辅助治疗，其中58%（46/79）接受了美加净治疗，24%（19/79）接受了来曲唑治疗，18%（14/79）接受了其他激素治疗。接受美加净与来曲唑辅助治疗的患者在RFS（P = 0.159）和OS（P = 0.167）方面没有明显差异。首次复发时，接受 Megace 治疗的患者的 RFS 与来曲唑治疗的患者相似（p = 0.302），但 OS 更好（27 个月对 10 个月，p = 0.018）。雌激素、平滑肌肌动蛋白和desmin阴性与较低的RFS（分别为p = 0.039、p = 0.002和p = 0.015）和OS（分别为p = 0.008、p = 0.012和p = 0.013）相关。淋巴管侵犯与较低的RFS相关（p = 0.033），孕酮阴性与较低的OS相关（p = 0.003）。对于复发性疾病，Megace可能具有潜在的生存优势。需要进一步研究确定治疗LG-ESS最有效的药物及其使用顺序。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy