Prognostic significance of steroid receptor positivity and adjuvant progestogen use in endometrial stromal sarcoma

Aust N Z J Obstet Gynaecol. 2014 Oct;54(5):453-6. doi: 10.1111/ajo.12245.

Abstract

Background: The prognostic significance of oestrogen and progesterone receptors (ER/PR) in endometrial stromal sarcoma (ESS) has conflicting reports in the literature, and the routine use of adjuvant progestogen is of uncertain efficacy.

Aims: To examine the prognostic significance of ER/PR positivity and of primary adjuvant progestogen use with outcome in ESS.

Materials and methods: All women with a diagnosis of ESS in our tertiary institution and associated private practices over the last 23 years were included. Primary variables were ER/PR positivity and adjuvant progestogen use. Other variables included high-grade disease and extrauterine disease. The primary outcome was survival, and the secondary outcome was recurrence-free survival (both overall and at 5 years). Survival was calculated using the Kaplan-Meier method. Univariate analyses were performed with t-test for means and chi-squared test for proportions, and multivariate analysis was used to control for age.

Results: 35 women were included. ER/PR positivity was associated with a survival benefit (OR death 0.22, P = 0.02), but primary adjuvant progestogen was not. High-grade disease (OR 13, P = 0.02) and extrauterine disease (OR 8.7, P = 0.04) were associated with decreased survival. No variable significantly affected recurrence-free survival. Eight of ten cases of recurrence treated with progestogen have survived more than 3 years.

Conclusions: ER/PR positivity appears to be useful for prognosis, but routine administration of primary adjuvant progestogen is not supported. There may be a role for progestogen in ER/PR positive tumours with recurrence or incomplete surgical clearance, but further research is required.

Keywords: endometrial stromal; endometrial stromal tumours; progestins; receptors; sarcoma; steroid.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chemotherapy, Adjuvant
  • Endometrial Neoplasms / chemistry
  • Endometrial Neoplasms / drug therapy*
  • Endometrial Neoplasms / surgery
  • Female
  • Humans
  • Middle Aged
  • Progestins / therapeutic use*
  • Prognosis
  • Receptors, Estrogen / analysis*
  • Receptors, Progesterone / analysis*
  • Sarcoma, Endometrial Stromal / chemistry
  • Sarcoma, Endometrial Stromal / drug therapy*
  • Sarcoma, Endometrial Stromal / surgery

Substances

  • Progestins
  • Receptors, Estrogen
  • Receptors, Progesterone