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High-grade endometrial stromal sarcoma versus undifferentiated uterine sarcoma: a Turkish uterine sarcoma group study-001

  • Gynecologic Oncology
  • Published:
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Abstract

Objective

Prognostic factors associated with high-grade endometrial stromal sarcoma (HGESS) and undifferentiated uterine sarcoma (UUS) have not been distinctly determined due to the repetitive changes in the World Health Organization (WHO) classification. We aimed to compare clinicopathologic features and outcomes of patients with HGESS with those of patients with UUS.

Methods

A multi-institutional, retrospective, cohort study was conducted including 71 patients, who underwent surgery at 13 centers from 2008 to 2017. An experienced gynecopathologist from each institution re-evaluated the slides of their own cases according to the WHO2014 classification. Factors associated with refractory/progressive disease, recurrence or death were examined using logistic regression analyses. Kaplan–Meier method and log-rank test were used for survival comparisons.

Results

The median disease-free survival (DFS) for HGESS and UUS was 12 months and 6 months, respectively. While the median overall survival was not reached in HGESS group, it was 22 months in the UUS group. Kaplan–Meier analyses revealed that patients with UUS had a significantly poorer DFS than those with HGESS (p = 0.016), although OS did not differ between the groups (p = 0.135). Lymphovascular-space involvement (LVSI) was the sole significant factor associated with progression, recurrence or death for HGESS (Hazard ratio: 9.353, 95% confidence interval: 2.539–34.457, p = 0.001), whereas no significant independent factor was found for UUS.

Conclusions

UUS has a more aggressive behavior than HGESS. While no significant predictor of prognosis was found for UUS, LVSI is the sole independent prognostic factor for HGESS, with patients 9.3 times more likely to experience refractory/progressive disease, recurrence or death.

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Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Ali Ayhan & Mehmet Tunc

  2. Department of Gynecologic Oncology, Saglik Bilimleri University Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey

    Nurettin Boran

  3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey

    Ghanim Khatib

  4. Department of Gynecologic Oncology, Saglik Bilimleri University Izmir Tepecik Education and Research Hospital, Izmir, Turkey

    Mehmet Gokcu

  5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Tayup Simsek

  6. Department of Pathology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Ozlem Isiksacan Ozen

  7. Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Varlik m, 07100, Antalya, Turkey

    Tayfun Toptas

  8. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

    Ibrahim Yalcin

  9. Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey

    Mehmet Mutlu Meydanli

Authors
  1. Ali Ayhan
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Contributions

AA: protocol/project development, supervision. MT: data collection or management. NB: data collection or management. GK: data collection or management. MG: data collection or management. TS: data collection or management. OO: data collection or management, manuscript editing. TT: data collection or management, data analysis, manuscript editing. IY: data collection or management, data analysis. MMM: protocol/project development, manuscript writing, supervision.

Corresponding author

Correspondence to Tayfun Toptas.

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The authors declare that they have no conflicts of interest and nothing to disclose.

Ethical approval

This study has been approved by the Ethics Committee of the Saglik Bilimleri University, Ankara City Hospital (Date: 06/01/2020, Decision no.: 10). This article does not contain any studies with human participants or animals performed by any of the authors.

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Ayhan, A., Tunc, M., Boran, N. et al. High-grade endometrial stromal sarcoma versus undifferentiated uterine sarcoma: a Turkish uterine sarcoma group study-001. Arch Gynecol Obstet 304, 475–483 (2021). https://doi.org/10.1007/s00404-020-05915-6

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